Clinical Study of Roux Stasis Syndrome after Distal Gastrectomy

Background: Because of the challenge of jejunal closure recanalization, uncut Roux-en-Y reconstruction remains controversial. This study aimed to investigate the incidence of recanalization after uncut Roux-en-Y reconstruction in pigs and a small number of patients.Methods: Twenty miniature pigs were subjected to distal gastrectomy and uncut Roux-en-Y reconstruction using various rows of linear staplers to block the intestine. The pigs were sacrificed, and the incidence of recanalization was investigated 1 month after the operation. From December 2018 to June 2019, 10 patients with gastric cancer who had undergone elective laparoscopy-assisted distal gastrectomy and uncut Roux-en-Y reconstruction were included in this study. The primary study outcome was recanalization of the afferent limb, demonstrated by gastrointestinal radiography 1, 3, and 6 months after surgery. Various numbers of staple lines across the afferent jejunal limb were applied for closure: 2 staple lines in 2 pigs, 4 staple lines in 6 pigs, 6 staple lines in 8 pigs, and 8 staple lines in 4 pigs.Results: Complete recanalization was detected in all 20 pigs 1 month postoperatively. Recanalization was detected in five cases (50%) by gastrointestinal radiography. Among them, 1 case of recanalization was found in the 1st month after the operation, 2 cases were found in the 3rd month, and another 2 cases were found in the 6th month. Bile reflux was detected by endoscopy in 2 patients with recanalization.Conclusions: The occurrence of afferent limb recanalization after uncut Roux-en-Y reconstruction is high, and using additional staplers alone cannot decrease the incidence of recanalization. Based on our study, uncut Roux-en-Y reconstruction is not recommended.

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Fixation of Roux Limb and Duodenal Stump Effects the Prevention of Peterson’s Internal Hernia and Roux Stasis Syndrome After Laparoscopic Distal Gastrectomy

10.21203/rs.2.16629/v1 ◽

2019 ◽

Author(s):

Jian-zhong Wu ◽

Hajime Orita ◽

Shun Zhang ◽

Hiroyuki Egawa ◽

Yoshinori Kohira ◽

...

Keyword(s):

Internal Hernia ◽

Distal Gastrectomy ◽

Rare Complication ◽

Case Series ◽

Laparoscopic Distal Gastrectomy ◽

Roux Limb ◽

Duodenal Stump ◽

Alimentary Limb ◽

Roux Stasis Syndrome ◽

Petersen’S Hernia

Abstract Background Roux-en-Y (R-Y) reconstruction is a standard option for reconstruction after laparoscopic distal gastrectomy (LDG). Though this technique takes more time than Billroth I (B-I) reconstruction, leakage is rare, and it is useful for management of a small remnant stomach. Complications occur and include Petersen’s hernia and Roux stasis syndrome. Petersen’s hernia is a rare complication that results in significant morbidity and poor quality of life.Here we report a case series of a simple and effective method for preventing Petersen’s hernia and Roux stasis syndrome.Methods We performed ante-colic R-Y reconstruction after LDG. After R-Y reconstruction, we fixed the alimentary limb onto the duodenal stump in a proper radian. Via this small improvement in the Roux limb, the alimentary limb was placed to the right of the ligament of Treitz. This not only changed the anatomy of the Petersen’s defect, but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy.Results From July 2015 to March 2017, we performed this technique in 31 consecutive patients. The operative time was (308.0 ± 84.6 minutes). Fixation of the alimentary limb onto the duodenal stump took about 10 minutes. Two (6.5%) patients experienced pneumonia and pancreatitis, respectively. No patient required reoperation or readmission. All patients were followed up for at least 2 years, and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.Conclusions This 10 minute technique is a very effective method to reduce the onset of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.

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Three cases of Roux stasis syndrome after distal gastrectomy successfully treated with a W‐ED tube

The Japanese Journal of SURGICAL METABOLISM and NUTRITION ◽

10.11638/jssmn.54.4_211 ◽

2020 ◽

Vol 54 (4) ◽

pp. 211-215

Author(s):

Takuji Kagiya ◽

Akitoshi Kimura ◽

Kensuke Okano ◽

Takeyuki Sawano ◽

Motonari Ohashi ◽

...

Keyword(s):

Distal Gastrectomy ◽

Roux Stasis Syndrome

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Antecolic Reconstruction Is a Predictor of the Occurrence of Roux Stasis Syndrome After Distal Gastrectomy

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-015-2770-y ◽

2015 ◽

Vol 19 (5) ◽

pp. 821-824 ◽

Cited By ~ 8

Author(s):

Ryota Otsuka ◽

Toshiyuki Natsume ◽

Takashi Maruyama ◽

Hajime Tanaka ◽

Hiroshi Matsuzaki

Keyword(s):

Distal Gastrectomy ◽

Roux Stasis Syndrome

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A Clinical Study of Twenty-seven Children Exhibiting Functional Hearing Loss

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1201.26 ◽

1981 ◽

Vol 12 (1) ◽

pp. 26-35 ◽

Cited By ~ 14

Author(s):

Donald L. McCanna ◽

Giacinto DeLapa

Keyword(s):

Hearing Loss ◽

Clinical Study ◽

Early Identification ◽

Behavioral Responses ◽

Upper Elementary ◽

Elementary Grades ◽

Ability Level ◽

Hearing Problem

This report reviews 27 cases of children exhibiting functional hearing loss. The study reveals that most students were in the upper elementary grades and were predominantly females. These subjects were functioning below their ability level in school and were usually in conflict with school, home, or peers. Tests used were selected on the basis of their helping to provide early identification. The subjects' oral and behavioral responses are presented, as well as ways of resolving the hearing problem. Some helpful counseling techniques are also presented.

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