The uncut Roux-en-Y with jejunal
pouch: a new reconstruction
technique for total gastrectomy
Kongkrit Chaiyasate, MD, Michael Jacobs, MD, FACS, Steven E. Brooks, MD,
Gelen del Rosario, MD, PhD, Lee Andrus, LVT, William Kestenberg, MD, FACS,
and Vijay Mittal, MD, FACS, Southfield, Mich
Background. Roux Stasis Syndrome is a well-known complication after Roux-en-Y reconstruction. It
has been hypothesized that reconstruction with an uncut Roux limb and jejunal pouch after total
gastrectomy would preserve unidirectional intestinal myoelectrical activity, improve postoperative weight
gain and nutritional parameters, and diminish Roux Stasis Syndrome in canines.
Methods. A total gastrectomy was performed, and 2 methods were used for reconstruction: Roux-en-Y
esophagojejunostomy (RY) was performed on 5 canines (control), and the uncut Roux-en-Y with a
jejunal pouch (URYJP) was performed on 5 other canines (experimental). The canines were monitored
for 10 weeks postoperatively. Serial weight and nutritional parameters were measured. Emptying
profiles and motility studies were performed in the fasting and postprandial states.
Results. Ten weeks after operation, the URYJP group had significantly improved nutritional
parameters, including weight, total protein, albumin, hemoglobin, serum total iron binding capacity,
and serum IgA, IgG, and IgM. The emptying times for both groups were similar, with an increase of
disordered propagation of the jejunal pacesetter potential in the RY group. The aboral propagation
occurred more frequently in the URYJP group during fasting and after feeding (98% 1% vs
39% 16%; P = .02, and 99% 1% vs 43% 18%; P = .03). The sites of luminal
occlusions were intact in the URYJP group at 10 weeks.
Conclusions. The combination of jejunal pouch and uncut Roux limb improved overall nutritional
parameters when compared with the traditional Roux-en-Y, while preserving aboral propagation of
jejunal pacesetter potentials. (Surgery 2007;142:33-9.)
From the Department of Surgery, Providence Hospital and Medical Centers, Southfield, Mich
The ideal post– gastrectomy reconstruction
technique would enable food intake, improve the
quality of life, and restore intestinal transit. Unfor-
tunately, many patients who undergo a Roux-en-Y
esophagojejunostomy develop symptoms associated
with the “Roux Stasis Syndrome.”
1
These symptoms
are caused by the electrical and motor abnormalities
in the Roux limb combined with the development of
ectopic pacemakers that drive contractions in the
reverse or oral direction, thereby accentuating stasis
and slowing emptying
2-4
(Fig 1, A).
The “uncut Roux” reconstructive technique was
devised in an effort to avoid jejunal transection,
maintain electrical continuity, and eliminate the
development of ectopic pacemakers.
5
This proce-
dure has been duplicated and found to be success-
ful in promoting myoelectric continuity in the
aboral direction and in preventing the formation
of ectopic pacemakers.
4,6
Despite these advances,
the procedures did not incorporate the addition of
a pouch reservoir for nutritional benefit, and staple
line dehiscences were reported.
7-9
Herein, we describe a new method of recon-
struction after total gastrectomy called the “uncut
Roux-en-Y with jejunal pouch” (URYJP). The uncut
design was chosen to avoid the development of
ectopic pacemakers and to promote aboral conduc-
tion (Fig 1, B). A pouch was incorporated for its
reservoir function. Finally, a luminal occlusion
technique was created to preserve myoelectric con-
duction without dehiscence. We hypothesized that
this novel procedure would preserve pacesetter po-
Accepted for publication March 3, 2007.
Reprint requests: Kongkrit Chaiyasate, MD, Department of Sur-
gery, Providence Hospital and Medical Centers, 16001 W. Nine
Mile Road, Southfield, MI 48075. E-mail: kchaiyas@msn.com.
0039-6060/$ - see front matter
© 2007 Mosby, Inc. All rights reserved.
doi:10.1016/j.surg.2007.03.003
SURGERY 33