A new model for improved gastrectomy drainage.

Abstract

Slow waves in isolated jejunal segments have been shown, in at least two studies, to have an increased percentage of neither prograde nor retrograde progression. Instead the pattern has been characterized as "nonpropagating" by Johnson and Sarna et al., and "chaotic" by others. We compared gastric drainage produced by a Roux-Y created with a single transection, with gastric drainage produced by a Roux-Y created in a jejunal segment isolated between two transections. Theoretically, this avoids the retrograde slow waves produced by a single transection. Ten dogs of either gender were divided into two groups of five. One group was given a truncal vagotomy, hemigastrectomy, and a standard Roux-Y drainage with a single jejunal transection; the other five were given the same operation with a distal jejunal transection and anastomosis 25 cm beyond the jejunojejunostomy (thus creating the Roux-Y in an isolated segment). In the approximate 50-day follow-up, 3 of 5 animals with standard preparations developed considerable difficulty in maintaining nutrition and developed hugely dilated stomachs. Animals with stomachs drained by the isolated jejunal segment Roux-Y had less difficulty maintaining nutrition and experienced minimal gastric dilatation. These findings were confirmed by upper gastrointestinal series at 2 weeks and at autopsy. In conclusion, this study shows that gastric drainage following truncal vagotomy and hemigastrectomy is enhanced by a Roux-Y created in an isolated jejunal segment.