Frequency of Roux Stasis Syndrome is Different in Uncut or Conventionel Roux-Y Procedures

Abstract

Objective: One of the main problems of conventional Roux-Y (C-RY) procedures is Roux stasis syndrome. To avoid this problem, an alternative technique called Uncut Roux-Y (U-RY) has been proposed in the literature. The aim of this article is to present the results of our patients who underwent C-RY and U-RY and to compare the incidence of Roux stasis between these two methods. Materials and Methods: The medical records of all patients who underwent C-RY and U-RY procedures at Manisa Celal Bayar University Department of General Surgery and Tepecik Teaching Hospital General Surgery Clinic between January 1989 and January 2018 were retrospectively reviewed. The incidence of Roux stasis in both procedures was investigated. Results: A total of 64 C-RY and 42 U-RY anastomoses were performed in 106 patients. Of the 64 C-RYs, 17 were performed for gastric cancer, 17 for bilienteric diversion, 25 for alkaline reflux gastritis and 5 for pancreatic pseudocyst. Of the 42 U-RYs, 18 were performed for gastric cancer, 18 for biliaryenteric diversion, 4 for alkaline reflux gastritis and 2 for pancreatic pseudocyst. A total of 38 complications occurred in 28 patients in the postoperative period. Roux stasis developed in 7 patients (14.1%) who underwent C-RY and 2 patients (4.8%) who underwent U-RY. There was no statistically significant difference in the development of Roux stasis between these two methods (p>0.05). Conclusion: The incidence of Roux stasis is lower in U-RY anastomosis compared to C-RY anastomosis. U-RY operation may be an effective method to prevent both duodenogastric reflux and roux stasis, especially in patients undergoing gastroenterostomy via omega loop. In addition, surgically, the U-RY technique is easier to perform than the C-RY technique. Therefore, U-RY operation is one of the techniques that can be preferred in laparoscopic or open gastroesophageal and biliary surgery.

Keywords

• Roux-Y Stasis Syndrome
• Uncut Roux-Y Limb
• Conventionel Roux-Y Ans

Roux Stasis Sendromunun Sıklığı Kesilmemiş veya Geleneksel Roux-Y Prosedürlerinde Farklıdır

Abstract

Amaç: Konvansiyonel Roux-Y (C-RY) prosedürlerinin ana sorunlarından biri Roux staz sendromudur. Bu sorunu önlemek için literatürde Uncut Roux-Y (U-RY) olarak adlandırılan alternatif bir teknik önerilmiştir. Bu makalenin amacı C-RY ve U-RY yapılan hastalarımızın sonuçlarını sunmak ve bu iki yöntem arasındaki Roux staz görülme oranını karşılaştırmaktır. Gereç ve Yöntem: Ocak 1989 ile Ocak 2018 tarihleri arasında Manisa Celal Bayar Üniversitesi Genel Cerrahi Anabilim Dalı ve Tepecik Eğitim Hastanesi Genel Cerrahi Kliniği'nde C-RY ve U-RY prosedürleri uygulanan tüm hastaların tıbbi kayıtları retrospektif olarak incelendi. Her iki prosedürde Roux stazı görülme oranı araştırıldı. Bulgular: Toplam 106 hastanın 64’üne C-RY, 42’sine U-RY anastomozu uygulandı. 64 C-RY'nin 17'si mide kanseri, 17'si biliyerenterik diversiyon, 25'i alkalen reflü gastrit ve 5’i pankreatik psödokist nedeniyle yapıldı. 42 U-RY'nin 18'i mide kanseri, 18'i biliyerenterik diversiyon, 4’ü alkalen reflü gastrit ve 2’si pankreatik psödokist nedeniyle yapıldı. 28 hastada ameliyat sonrası dönemde total 38 komplikasyon meydana geldi. C-RY yapılan 7 hastada (%14,1) ve U-RY yapılan 2 hastada (%4,8) Roux stazı gelişti. Bu iki yöntem arasında Roux stazı gelişmesi açısından istatistiksel olarak anlamlı fark saptanmadı. (p>0.05) Sonuç: Roux stazı görülme oranı, U-RY anastomozunda C-RY anastomozuna göre daha düşüktür. U-RY operasyonu, özellikle omega loop üzerinden gastroenterostomi yapılan hastalarda hem duodenogastrik reflüyü hem de roux stazını önlemede etkili bir yöntem olabilir. Ayrıca cerrahi açıdan U-RY tekniğinin uygulaması C-RY tekniğine göre daha kolaydır. Bu nedenle U-RY operasyonu, laparoskopik veya açık gastroözofageal ve biliyer cerrahide tercih edilebilecek tekniklerden biridir.

Keywords

• Roux-Y Staz Sendromu
• Kesilmemiş Roux-Y Prosedürü
• Konvansiyonel Roux-Y Ans.

References

1. AbdelRafee, A., El-Shobari, M., Askar, W., Sultan, A. M., & El Nakeeb, A. (2015). Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study. International Journal of Surgery, 18, 205–210. https://doi.org/10.1016/j.ijsu.2015.05.004
2. Bismuth, H., Franco, D., Corlette, M. B., & Hepp, J. (1978). Long term results of Roux-en-Y hepaticojejunostomy. Surgery, Gynecology & Obstetrics, 146(2), 161–167.
3. Britton, J. P., Johnston, D., Ward, D. C., Axon, A. T. R., & Barker, M. C. J. (2005). Gastric emptying and clinical outcome after Roux-en-Y diversion. British Journal of Surgery, 74(10), 900–904. https://doi.org/10.1002/bjs.1800741010
4. Ducrotte, P., Peillon, C., Guillemot, F., Testart, J., & Denis, P. (1991). Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies? A manometric study. The American Journal of Gastroenterology, 86(9), 1255–1258.
5. Gustavsson, S., Ilstrup, D. M., Morrison, P., & Kelly, K. A. (1988). Roux-Y stasis syndrome after gastrectomy. The American Journal of Surgery, 155(3), 490–494. https://doi.org/10.1016/S0002-9610(88)80120-X
6. Hinder, R. A., Esser, J., & DeMeester, T. R. (1988). Management of gastric emptying disorders following the Roux-en-Y procedure. Surgery, 104(4), 765–772.
7. Jangjoo, A., Mehrabi Bahar, M., & Aliakbarian, M. (2010). Uncut Roux-en-y esophagojejunostomy: A new reconstruction technique after total gastrectomy. Indian Journal of Surgery, 72(3), 236–239. https://doi.org/10.1007/s12262-010-0059-7
8. Karlstrom, L. H., Soper, N. J., Kelly, K. A., & Phillips, S. F. (1989). Ectopic jejunal pacemakers and enterogastric reflux after Roux gastrectomy: effect of intestinal pacing. Surgery, 106(3), 486–495.

9. Kiciak, A., Woliñski, J., Borycka, K., Zabielski, R., & Bielecki, K. (2007). Roux‐en‐Y or ‘uncut’ Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs. Experimental Physiology, 92(2), 399–408. https://doi.org/10.1113/expphysiol.2006.035253
10. Klaus, A., Hinder, R. A., Nguyen, J. H. ., & Nelson, K. L. (2003). Small bowel transit and gastric emptying after biliodigestive anastomosis using the uncut jejunal loop. The American Journal of Surgery, 186(6), 747–751. https://doi.org/10.1016/j.amjsurg.2003.08.025
11. Ma, J.-J., Zang, L., Yang, A., Hu, W.-G., Feng, B., Dong, F., Wang, M.-L., Lu, A.-G., Li, J.-W., & Zheng, M.-H. (2017). A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience. Surgical Endoscopy, 31(11), 4749–4755. https://doi.org/10.1007/s00464-017-5551-8
12. Miedema, B. W. (1992). The Roux Stasis Syndrome. Archives of Surgery, 127(3), 295. https://doi.org/10.1001/archsurg.1992.01420030057011
13. Morrison, P., Miedema, B. W., Kohler, L., & Kelly, K. A. (1990). Electrical dysrhythmias in the roux jejunal limb: Cause and treatment. The American Journal of Surgery, 160(3), 252–256. https://doi.org/10.1016/S0002-9610(06)80017-6 Nguyen Tu, B., & Kelly, K. A. (1995). Elimination of the Roux stasis syndrome using a new type of “uncut Roux” limb. The American Journal of Surgery, 170(4), 381–386. https://doi.org/10.1016/S0002-9610(99)80308-0
14. Noh, S.-M. (2000). Improvement of the Roux limb function using a new type of “uncut Roux” limb. The American Journal of Surgery, 180(1), 37–40. https://doi.org/10.1016/S0002-9610(00)00421-9
15. Park, J. Y., & Kim, Y. J. (2014). Uncut Roux-en-Y Reconstruction after Laparoscopic Distal Gastrectomy Can Be a Favorable Method in Terms of Gastritis, Bile Reflux, and Gastric Residue. Journal of Gastric Cancer, 14(4), 229. https://doi.org/10.5230/jgc.2014.14.4.229
16. Park, Y. S., Shin, D. J., Son, S., Kim, K., Park, D. J., Ahn, S., Park, D. J., & Kim, H. (2018). Roux Stasis Syndrome and Gastric Food Stasis After Laparoscopic Distal Gastrectomy with Uncut Roux‐en‐Y Reconstruction in Gastric Cancer Patients: A Propensity Score Matching Analysis. World Journal of Surgery, 42(12), 4022–4032. https://doi.org/10.1007/s00268-018-4715-6
17. Sah, B. K., Li, J., Yan, C., Li, C., Yan, M., & Zhu, Z. G. (2020). Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y? BMC Surgery, 20(1), 7. https://doi.org/10.1186/s12893-019-0672-8
18. Stefanini, P., Carboni, M., Patrassi, N., Basoli, A., Bernardinis, G. De, & Negro, P. (1975). Roux-en-Y Hepaticojejun ostomy. Annals of Surgery, 181(2), 213–219. https://doi.org/10.1097/00000658-197502000-00016
19. Sun, M.-M., Fan, Y.-Y., & Dang, S.-C. (2018). Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis. World Journal of Gastroenterology, 24(24), 2628–2639. https://doi.org/10.3748/wjg.v24.i24.2628
20. Tireli, M. (2012). The results of the surgical treatment of alkaline reflux gastritis. Hepato-gastroenterology, 59(119), 2352-2356