Study of the antireflux function of the Roux-en-y jejunal loop in reconstruction following gastrectomy

Abstract

Persistance of global orthograde peristaltic propulsion in the Y jejunal loop according to Roux makes this latter adequate for reconstruction of digestive transit after gastric resection or total gastrectomy, simultaneously avoiding reflux. Ectopic pacemakers can set in its proximal tract and favor intestinal and bile juice reflux in the gastric stump or esophagous, expecially if the loop is too short and the new pacemaker is far from its superior margin. Moreover, the slower peristaltic waves can favor a relative stasis and, thus, a containing function, which could represent an element of morbidity over a certain limit. If the Y loop is not too long, but long enough to include the higher frequency ectopic pacemaker, which overcomes the lower frequency ones located distally, the positive aspects of both these characteristics can be exploited for satisfying and free of morbidity results. We believe that the best length is 35-40 cm, with positive clinical results. 99Tc-HIDA sequential scintigraphy clearly shows the absence of bile material reflux in the digestive tract proximal to the anastomosis.