Small bowel transit and gastric emptying after biliodigestive anastomosis using the uncut jejunal loop - 26/08/11

Doi : 10.1016/j.amjsurg.2003.08.025

Alexander Klaus, M.D. ^a,^c, Ronald A Hinder, M.D. ^a,^⁎ , Justin H.H Nguyen, M.D. ^a, Kevin L Nelson, Ph.D. ^b
^a Department of Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
^b Radiation Safety Department, Mayo Clinic Jacksonville, Jacksonville, FL, USA
^c Department of General and Transplant Surgery, University Hospital Innsbruck, Innsbruck, Austria

^*Corresponding author. Tel.: +1-904-953-2523; fax: +1-904 953-2432.

Abstract

Background

The Roux-en-Y loop is an effective procedure for biliodigestive drainage. However, up to 15% of patients suffer from postoperative cholangitis or blind loop syndrome. A new technique to prevent motility abnormalities has been developed.

Methods

Male Lewis rats were used to compare gastric emptying and transit in the small bowel after either a standard Roux-en-Y anastomosis or a new biliodigestive anastomosis technique which involves creating an “uncut” jejunal loop with luminal occlusion. Unoperated rats served as controls. ⁹⁹Technetium HIDA and ¹¹¹Indium-tagged amberlite were respectively used to investigate small bowel transit and gastric emptying.

Results

Histopathology showed distinctive abnormalities only in the liver of conventional Roux-en-Y animals. No recanalization of the obliterated gut lumen occurred in uncut Roux animals. Distribution of ⁹⁹Tc-HIDA and ¹¹¹In showed were similar in both groups. Gastric emptying is slowed in both groups.

Conclusions

The uncut proximal jejunum loop is a good alternative to the conventional Roux-en-Y loop and showed preserved small bowel motility and adequate jejunal transit. Gastric emptying is slowed in both groups.

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Keywords : Biliodigestive anastomosis, Roux-en-Y, Motility, Cholangitis