Abstracts
1997 Digestive Disease Week

Teflon buttress inhibits recanalization of the "uncut" Roux limb.

WS Richardson, H Spivak, JE Hudson, MA Budacz, JG Hunter. Emory University School of Medicine, Atlanta, GA.

The uncut Roux limb operation is designed to have the benefits of a Roux limb but still have electrical continuity from proximal to distal bowel thus eliminating the risk of Roux stasis syndrome. Recanalization of the uncut staple line leading to bile reflux has been the main complication of the operation. Aim: The aim of this study is to employ a new technique which will not allow recanalization of an uncut staple line but will not interfere with normal bowel myoelectric activity. Methods: 14 mongrel dogs 25-35 Kg underwent a midline laparotomy after general anesthesia. An uncut staple line was placed 25 centimeters from the ligament of Treitz. In 7 animals an uncut staple line alone was placed, and in the 7 animals the bowel was stapled between a sandwich of Teflon reinforcing strips such that the staples were held on both sides of the bowel by the Teflon. A jejunojejunostomy was placed 6 centimeters proximal to the staple line in all animals. Insulated bipolar electrical leads were placed 2cm & 4cm proximal and 2cm & 4cm distal to the staple line. The ends of the leads were placed through the bowel serosa and covered with an insulating Teflon patch. The free ends were brought through a flank incision. The electrical leads were monitored two days to three months postoperativily for bowel myoelectric activity. Afterwards the animals were sacrificed and the operative sites inspected. Results: None of the animals suffered morbidity or mortality from the procedure. All 7 unreinforced staple lines recanalized and all 7 reinforced staple lines remained competent. The duodenal pacemaker was transmitted through the staple line in 5 animals (three control and two with Teflon reinforcement) within a week postoperatively. In 7 animals aberrant orad conduction of action potentials was noted distal to the staple line in the first week which converted to abberrent anad conduction in three months. Two animals were sacrificed early and both had aberrant anad conduction distal to the staple line. Conclusion: The uncut staple line does not reliably transmit the duodenal pacemaker, but anad conduction of action potentials reliably occurs with time. The staple line does not significantly recanalize when it is reinforced with a permanent material. This is a good method for preventing recanalization in the "uncut" Roux limb operation.