Roux-en-Y anastomosis

Schematic of gastric bypass using a Roux-en-Y anastomosis. The transverse colon is not shown so that the Roux-en-Y can be clearly seen. The variant seen in this image is retrocolic, retrogastric, because the distal small bowel that joins the proximal segment of stomach is behind the transverse colon and stomach.

In general surgery, a Roux-en-Y anastomosis, or Roux-en-Y, is a surgically created end-to-side anastomosis, most commonly performed for weight loss or to remove a malignancy. Typically, it is between stomach and small bowel that is distal (or further down the gastrointestinal tract) from the cut end.^[1]

Overview

The name is derived from the surgeon who first described it (César Roux)^[1] and the stick-figure representation. Diagrammatically, the Roux-en-Y anastomosis looks a little like the letter Y.

Typically, the two upper limbs of the Y represent (1) the proximal segment of stomach and the distal small bowel it joins with and (2) the blind end that is surgically divided off, and the lower part of the Y is formed by the distal small bowel beyond the anastomosis.

Roux-en-Ys are used in several operations and collectively called Roux operations.^[1]

When describing the surgery, the Roux limb is the efferent or antegrade limb that serves as the primary recipient of food after the surgery, while the hepatobiliary or afferent limb that anatamoses with biliary system serves as the recipient for biliary secretions, which then travel through the residual stomach from the liver and into the Roux limb to aid digestion. The altered anatomy can contribute to indigestion following surgery.^[2]

Operations that make use of a Roux-en-Y

• Some gastric bypasses for obesity.
• Roux-en-Y reconstruction following partial or complete gastrectomy for stomach cancer.^[3]
• Roux-en-Y hepaticojejunostomy used to treat (macroscopic) bile duct obstruction which may arise due to:
  • a common bile duct tumour or hepatic duct tumour (e.g. resection of cholangiocarcinoma)^[4]
  • a bile duct injury (e.g. cholecystectomy, iatrogenic, trauma)
  • an infection/inflammation (e.g. pancreatic pseudocyst)
• Roux-en-Y choledochojejunostomy - indications same as Roux-en-Y hepaticojejunostomy.
• Roux-en-Y pancreas transplant ^[5]
• Roux-en-Y pancreas reconstruction after blunt abdominal trauma.^[6]
• Roux-en-Y hepaticojejunostomy with gastrojejunostomy as palliation for irresectable pancreatic head cancer.^[7]

References

1. Roux operation. whonamedit.com. http://www.whonamedit.com/synd.cfm/3724.html. Accessed on: February 7, 2008.
2. Björklund, P; Laurenius, A; Een, E; Olbers, T; Lönroth, H; Fändriks, L (2010). "Is the Roux limb a determinant for meal size after gastric bypass surgery?". Obesity Surgery 20 (10): 1408–14. doi:10.1007/s11695-010-0192-1. PMC 2941084. PMID 20517654.
3. Surgery to remove stomach cancer. cancerhelp.org.uk. URL: http://www.cancerhelp.org.uk/help/default.asp?page=3917. Accessed on: February 7, 2008.
4. Lawrence PF. Essentials of general surgery. 3rd Ed. Lippincott Williams & Wilkins. 2000. ISBN 0-683-30133-0.
5. Shokouh-Amiri H, Zakhary JM, Zibari GB (April 2011). "A novel technique of portal-endocrine and gastric-exocrine drainage in pancreatic transplantation". Journal of the American College of Surgeons 212 (4): 730–8; discussion 738–9. doi:10.1016/j.jamcollsurg.2010.12.045. PMID 21463823.
6. Segura-Sampedro, JJ; Jiménez-Rodríguez, RM; Martos-Martínez, JM; Padillo-Ruiz, FJ (December 2012). "[Pancreatic rupture and Roux-en-Y reconstruction after abdominal trauma].". Cirugia espanola 90 (10): e39. doi:10.1016/j.ciresp.2011.07.018. PMID 22257412.
7. van Wagensveld, B. A., Coene, P. P. L. O., van Gulik, T. M., Rauws, E. A. J., Obertop, H. and Gouma, D. J. (October 1997). "Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients". British Journal of Surgery 84 (10): 1402–1406. doi:10.1111/j.1365-2168.1997.02799.x. PMID 9361599.

External links

• Anastomoses - thefreedictionary.com.