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Hartmut Thomas, MD; Johannes Heimbucher, MD; Karl H. Fuchs, MD; Stephan M. Freys, MD; Tom R. DeMeester, MD; Jeffrey H. Peters, MD; Cedric G. Bremner, MD; Arnulf Thiede, MD

Arch Surg. 1996;131(1):63-66.

Abstract
Objectives
To compare motility of a Roux-en-Y esophagojejunostomy after total gastrectomy with normal jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruction.

Design
Jejunal motility in normal subjects was compared with jejunal motility in the Roux-en-Y reconstruction with and without a Hunt-Lawrence pouch.

Setting
The cases were collected during a 4-year period at a university hospital. The mean time from resection to study was 14 months (range, 4 to 49 months).

Patients
Seven control patients were compared with 10 patients with a Roux-en-Y reconstruction and 17 with a Roux-en-Y and Hunt-Lawrence pouch.

Outcome Measure
The fasting-state motility of the jejunum used for reconstruction was measured by a waterperfused manometric system for 2 to 4 hours with the subject in the supine position.

Results
Compared with normal subjects, patients with a Roux-en-Y esophagojejunostomy without a pouch had an increased number of phases of the interdigestive motor complex per hour (P<.05). The phases were of shorter duration with a random sequence and increased total time spent in the quiescent phase 1 (P<.05). In patients with a pouch, no differences were detected between the motility in the pouch and the efferent limb. Compared with those without a pouch, there were significantly fewer orthograde interdigestive motor complex phase 3 fronts and more total time spent in phase 1 (P<.05).

Conclusions
Construction of a gastric substitute from jejunum leads to substantial motility changes. The addition of a pouch decreases the overall activity, which may contribute to the storage function of the pouch.

(Arch Surg. 1996;131:63-66)

Author Affiliations
From the Department of Surgery, University of Southern California School of Medicine, Los Angeles (Drs Thomas, Heimbucher, DeMeester, Peters, and Bremner); and Department of Surgery, University of Würzburg (Germany) (Drs Fuchs, Freys, and Thiede).

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