Accelerated gastric emptying including dumping syndrome occurs frequently after gastric resections largely resulting from rapid entry of meal contents into the small intestine. We hypothesized therefore that an ileocecal segment as an interpositional graft placed between the remaining part of the stomach and the small intestine would replace the pylorus and slow down food transit.
Methods: 30 Göttingen Minipigs were randomized into three groups. Group 1: partial gastrectomy and Roux-en-Y reconstruction ; group 2: partial gastrectomy and ileocecal interpositional graft; group 3: sham laparotomy. Gastric emptying in the non sedated animals was quantified using radioscintigraphy 3 and 6 months postoperatively. The animals ingested 300g soft food containing 99mTc labelled resin- pellets using a technique previously described (Stivland et al., Gastroenterology 1991; 101:107-115). Data were analysed using ANOVA.
Results: (Table):Mean±SEM; 3 months postoperatively, the ileocecal group had a significantly prolonged gastric emptying time compared with the Roux-en-Y group (p=0.012), but gastric emptying time was also significantly faster (p=0.012) compared to the control group (sham laparotomy). After 6 months no significant difference was seen between the ileocecal group and the controls (p=0.067), while emptying rates were still significantly faster in the Roux-en-Y group.
Conclusion: Reconstruction of the gastric reservoir with an ileocecal segment largely restores gastric emptying of food in Minipigs. 6 Months postoperatively, gastric emptying is similar to controls, and significantly slower than in the group with Roux-en-Y reconstruction. These results suggest that the ileocecal interposition graft could offer specific advantages over current reconstruction procedures.
Roux-en-Y Roux-en-Y Ileocecal Ileocecal Sham Sham
after 3 months after 6 months after 3 months after 6 months after 3 months after 6 months
Lag phase 30±6 48±12.8 68±13.2 97±34.2 194±38.6 184±35.7
T50 106±8.6 117±16.4 299±35.3 304±32.2 430±129.2 344±42.1