Gastric emptying of solids after Roux-en-Y gastrectomy : is extragastric vagal innervation important ?. Discussion

: Truncal vagotomy, antrectomy with Roux-en-Y gastrojejunostomy is frequently complicated by poor gastric emptying. The aim of this study was to determine whether the vagal denervation beyond the stomach (extragastric vagal denervation) contributes to this delay in gastric emptying. Three groups of six female mongrel dogs underwent antrectomy, Roux-en-Y gastrojejunostomy, and either truncal vagotomy, gastric vagotomy, or no vagotomy. After operation each dog underwent two separate radioisotope gastric-emptying studies with a small volume solid meal. The dogs were scanned by a gamma-camera continuously for 4 hours, and images of the gastric remnant were summed by computer every 6 minutes. Radioactivity in the gastric remnant region of interest was compared to overall activity and plotted as a function of time. The half-emptying times (X +/- SEM) for each group were truncal vagotomy 164 +/- 24 minutes, gastric vagotomy 79 +/- 23 minutes, and no vagotomy 117 +/- 10 minutes. Animals with a gastric vagotomy had a significantly faster rate of gastric emptying than did those with truncal vagotomy (p = 0.02, Scheffe's test). Therefore the extragastric vagal innervation appears to play a role in determining the rate of emptying of solids after antrectomy and Roux-en-Y gastrojejunostomy.