The Roux en Y distal gastric resection with preservation of the gastric remnant and jejunal innervation: a valid surgical option for the treatment of difficult benign situations of the upper gastro-intestinal tract

Background: The distal gastric resection with the Roux en y gastrojejunostomy has been proposed for the treatment of complex benign diseases involving the distal esophagus and gastro-esophageal junction, in alternative to esophageal resection, redo surgery and in case of concomitant esophageal and antrum functional or organic abnormalities. The rationale is to reduce gastric secretion, to divert bilio-pancreatic secretions, to preserve the motility of the gastric stump and the jejunal loop, in order to reduce the incidence and severity of the Roux stasis syndrome which may impair long term results in up to 50% of cases. In this video we show the technique and report the long term results. Methods: We performed a 2/3 distal gastrectomy comprehensive of the whole gastrin secreting mucosa, maintaining the innervation of the gastric fundus. The stomach resection line formed a 145° angle with the lesser curvature to obtain a toboggan like end to side gastro-jejunostomy. We did not divide the jejunal mesentery underneath the jejunum resection line, to preserve the intrinsic innervation. It was otherwise easy, to perform the end to side jejunal–jejunostomy at least 70 cm below the gastro-jejunostomy. Results: Clinical results were excellent in 11 out of 27 (40.8%), good in 10 (37%), fair in 1 (3.7%) and poor in 5 (18.5%) of whom 2 for Roux en Y Stasis Syndrome (global frequency 2/27 7.4%). Discussion: The Roux en Y gastrojejunostomy may be a valid solution for diffi cult upper gastro-intestinal problems, if performed according to surgical physiology principles. Disclosure: All authors have declared no confl icts of interest.