Migrating contractions of the afferent and Roux limbs show peristaltic movement independently of each other in conscious
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ORIGINAL ARTICLE
Migrating contractions of the afferent and Roux limbs show peristaltic movement independently of each other in conscious dogs after Roux‑en‑Y reconstruction after distal gastrectomy Masaki Suzuki1 · Takehiko Yokobori2 · Kyoichi Ogata1 · Nobuhiro Nakazawa1 · Akiharu Kimura1 · Norimichi Kogure1 · Erito Mochiki3 · Hiroyuki Kuwano1 Received: 17 June 2020 / Accepted: 20 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose The Roux-en-Y (RY) procedure is used frequently for surgical reconstruction after gastrectomy. However, a minority of patients suffer a serious motility disorder of the Roux and afferent limb postoperatively. We conducted this study to clarify the association between the motility and peristaltic direction of two limbs in conscious dogs. Methods We performed distal gastrectomy on five dogs and implanted seven force transducers on the serosal surfaces of the remnant gastric body and afferent and Roux limbs. We then analyzed the electric signals from these force transducers. Results Migrating contractions were observed in the two limbs, but not in the gastric remnant body. Migrating contractions in the forward direction propagated independently from the most proximal side in each limb. There was no propagation of contraction across the jejunojejunostomy between the two limbs. Conclusions Each proximal part of the Roux and afferent limbs has an independent motility pacemaker in conscious dogs after gastrectomy with RY reconstruction. Keywords Distal gastrectomy · Roux-en-Y reconstruction · Migrating contraction
Introduction The Roux-en-Y (RY) procedure is a popular technique for surgical reconstruction after total gastrectomy, distal gastrectomy, and pancreaticoduodenectomy [1, 2]. It has also been used recently in bariatric surgery [3]. This method, which was designed to avoid biliary reflux, was described first by Cesar Roux in 1897 [4]. Although most patients who undergo RY reconstruction have a good postoperative course, a minority experience serious problems postoperatively, such as Roux stasis [5] and afferent loop [6] * Masaki Suzuki [email protected] 1
Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
2
Research Program for Omics‑Based Medical Science, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
3
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
syndromes. Functional abnormality of the Roux limb and delayed gastric emptying have been proposed as possible causes of Roux stasis syndrome [7, 8]. Karlstone et al. [9] found that ectopic pacemakers arose in the Roux limb and triggered retrograde contractions. This phenomenon caused a functional obstruction in the Roux limb. The afferent loop syndrome may be caused by anastomotic obstruction of the jejunojejunostomy, as a result of internal herniation, adhesion, and recurrence [6]. Some reports
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