Abstracts
1999 Digestive Disease Week

# 2190 STANDARD ROUX-EN-Y GASTROJEJUNOSTOMY VS "UNCUT" ROUX-EN-Y GASTROJEJUNOSTOMY: A CASE-CONTROLLED STUDY.
R A Mon, Univ of Iowa Coll of Medicine, Iowa City, IA; Joseph J Cullen, Univ of Iowa and VA Med Ctr, Iowa City, IA

Roux-en-Y gastrojejunostomy is a common method of reconstruction after subtotal gastrectomy. However, 40% of patients then develop the so-called Roux stasis syndrome, consisting of chronic abdominal pain, nausea, vomiting, and postprandial bloating. Maintaining myoneural continuity has been proposed to decrease the incidence of Roux stasis syndrome, with an "uncut" Roux-en-Y, a modified Billroth II gastrojejunostomy in which staples occlude the afferent jejunal lumen, while biliary and pancreatic secretions are diverted distally through a jejunojejunostomy. However, early results suggest an unacceptable rate of staple line dehiscence (Am. J. Surg. 170:262, 1995) AIMS: 1) to review our clinical experience with the "uncut" Roux-en-Y gastrojejunostomy; 2) to compare the clinical results of patients who have undergone the "uncut" Roux-en-Y gastrojejunostomy to age- and disease-matched control patients who have undergone a standard Roux-en-Y gastrojejunostomy. METHODS: Between 1993 and 1998, 11 patients (5 M, 6 F) underwent gastrectomy and "uncut" Roux-en-Y gastrojejunostomy for gastric adenocarcinoma (3), gastroparesis (4), peptic ulceration with gastric outlet obstruction (1), and bile reflux gastritis (3). Additionally, patients who underwent gastrectomy and standard Roux-en-Y gastrojejunostomy were age- and disease-matched to the patients who underwent the "uncut" Roux procedure. Patients were contacted and charts were reviewed for Visick score, early and late morbidity and mortality, and incidence of staple line dehiscence. RESULTS: Early postoperative morbidity was 36% in patients undergoing the "uncut" Roux and 25% in patients undergoing the standard Roux but none was directly related to the type of gastric reconstruction. There was no early postoperative mortality in either group. In the "uncut" Roux patients there were no staple line dehiscences (mean follow-up 16 months, range 1-48 months). Visick rating improved in patients undergoing the "uncut" Roux, but changed little in the patients undergoing standard Roux (Table). CONCLUSIONS: "Uncut" Roux-en-Y gastrojejunostomy can be performed safely with improvement in symptoms and a low rate of staple line dehiscence. The "uncut" Roux may provide an alternative for reconstructive gastric surgery.

Visick rating
	Preoperative	Postoperative
"Uncut" Roux	3.1±0.2	1.8±0.3*
Standard Roux	3.5±0.3	3.0±0.1
Means SEM, *P<0.01 vs preoperative.

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