The Roux stasis syndrome. Treatment by pacing and prevention by use of an 'uncut' Roux limb
B. W. Miedema and K. A. Kelly
Department of Surgery, Mayo Clinic, Rochester, Minn.
Ectopic pacemakers in the Roux limb are associated with delayed gastric
emptying after Roux gastrectomy. The aim herein was to suppress the ectopic
pacemakers by electrical pacing or to prevent them by maintaining enteric
myoneural continuity with an "uncut" Roux limb, and so improve the delayed
emptying. Among eight dogs with truncal vagotomy and Roux hemigastrectomy,
four dogs had a pacing electrode applied to the proximal end of the Roux
limb. The other four dogs had a gastrojejunostomy to an uncut Roux limb. In
them, the afferent jejunal limb was occluded by staples but not divided,
and a diverting jejuno-jejunostomy was performed. Roux pacing and the uncut
Roux operation abolished ectopic pacemakers in the Roux limb and speeded
the slow gastric emptying present in unpaced control tests. At autopsy,
however, dehiscences were found in the staple line in the dogs with the
uncut Roux procedures. In conclusion, electrical pacing and the uncut Roux
limb show promise as techniques to prevent ectopic jejunal pacemakers and
gastric stasis after Roux gastrectomy. Both must be improved before they
can be used in patients.
