The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy

Abstract

Background Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome. It occurs in 10-30% of patients after such reconstruction. So far, the cause of this stasis has not been completely identified. This study aimed to reduce Roux stasis using surgical techniques. Methods From November 2007 to October 2010, we performed 101 distal gastrectomies with Roux-en-Y reconstruction. All the gastrojejunostomies were performed with end-to-end anastomoses. Roux stasis was analyzed with respect to tumor location, extent of the dissection, tumor progression, operation time, antecolic/retrocolic reconstruction, and the shape of the gastrojejunostomy. The shape of the gastrojejunostomy was evaluated by contrast gastroradiography 4 days after the operation. Results Roux stasis syndrome was observed in 17 of the 101 patients. There was no relationship between the extent of the dissection, tumor progression, or operation time and the occurrence of Roux stasis. There was no difference in the incidence of Roux stasis between antecolic and retrocolic reconstructions. However, the group that displayed a straight anastomotic shape on contrast radiography demonstrated an apparently lower incidence of Roux stasis (p = 0.0003). In addition, Roux-en-Y reconstruction following gastric cancer was more frequently followed by Roux stasis in the antrum than in the midstomach (p = 0.0036). Cases of Roux stasis occurred 11.8 days after surgery on average and resolved within 2 weeks on average. Conclusions Our findings demonstrate the substantial benefits of a straight anastomosis of the gastrojejunostomy for the prevention of Roux stasis syndrome.

Retrocolic Roux‐en‐Y anastomosis for total laparoscopic distal gastrectomy: Fix‐the‐remnant‐first technique

“…We performed gastrojejunostomy for functional end‐to‐end anastomosis to create a straight entry to the Roux‐en‐Y limb and to avoid making an angle or a stricture just after the anastomosis. One report has analyzed the cause of Roux‐en‐Y stasis, and the results indicate the importance of the angle of the anastomosis . This report supports the angle we selected for anastomosis, which helped provide out good results.…”

Effect of Standardizing the Incision Line on Delayed Gastric Emptying After Laparoscopic Gastrectomy: A Retrospective Preliminary Analysis

“…Approximately 10% of totally laparoscopic distal gastrectomy patients at our institution undergo R-Y reconstruction (data not shown). However, as Roux stasis syndrome, a form of functional obstruction, is known to occur with R-Y or B-II reconstruction [15,16], the advantages and disadvantages of each method should be fully considered when selecting the optimal surgical strategy. For both methods, making adjustments to avoid a positive stump, performing an oncologically radical resection, and reducing even mild complications are important.…”

Fixation of Roux Limb and Duodenal Stump Effects the Prevention of Peterson’s Internal Hernia and Roux Stasis Syndrome After Laparoscopic Distal Gastrectomy

“…In addition to reducing reflux, R-Y reconstruction potentially prevents the obstruction of the gastrointestinal anastomosis caused by recurrences around the pylorus and has a low incidence of anastomotic leak [23]. However, the rate of Roux stasis syndrome is higher in R-Y reconstruction than in Billroth Ⅰ reconstruction [24.25], which had been reported to range from 10% to 30% [12]. Many factors have been inferred as the cause of Roux stasis syndrome, including a relatively large gastric remnant [26], an ectopic pacemaker from the Roux limb [27], a long length of Roux limb [28] and vagotomy [29].…”

“…However, some patients may develop Roux stasis syndrome, which is related to a functional obstruction of the Roux limb and is characterized by abdominal pain, vomiting and post-prandial nausea [11]. The pathogenic mechanisms of Roux stasis syndrome are not completely identified, though the angle of the Roux limb may be a cause [12].…”