• G Arlt, V Schumpelick, and G Klöppel.
• Langenbecks Arch Chir. 1984 Jan 1; 362 (1): 43-52.

AbstractThe ulcer risk of the Roux-Y anastomosis following gastric resection was analyzed experimentally in 82 rats. After 1/3 gastric resection a Roux-Y gastrojejunostomy with jejunal loops of 3, 6, 9 and 15 cm was performed. 10 months postoperatively a follow-up was performed consisting of endoscopy, measurement of pH-values, analysis of gastric secretion and serum gastrin, gastric emptying tests and histamine stimulation. Endoscopically there was a high rate of stomal ulceration related to the length of the jejunal loop. In long Roux-Y loops (9 and 15 cm), that means under reflux-free conditions, ulcer incidence ranged from 72% to 92%. In short loops with reflux-exposed stomachs the frequency of ulceration was only 9%. With additional histamine stimulation there were stomal ulcers in 100% of the reflux-free animals, but only in 60% of the rats with short Roux-Y loops. In spite of resection acidity was high (pH 1.8) in reflux-free stomachs. Only the volume of gastric secretion and the amount of acid-output was reduced. Gastric acid secretion unbuffered by duodenal content is discussed as the major factor in the etiology of stomal ulcer in reflux-free stomachs. So the Roux-Y anastomosis following gastric resection is a modification of the Mann-Williamson experiment. Therefore reflux-free operations are heavily ulcer prone.

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