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To evaluate the functioning and effectiveness of a reversed jejunal segment after
extensive small bowel resection, we continuously measured the postoperative bowel
motility (using bipolar electrodes and/or contractile strain gage force transducers)
in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The
fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly
longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to
80% extensive small bowel resection (group 3) than in dogs that received extensive
resection alone (group 2) or dogs that underwent construction of a reversed jejunal
segment without bowel resection (group 1). The MMC arising from the duodenum was often
interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly
to the reversed segment or terminal ileum in group 3. In addition, brief small discordant
contractions were frequent in the reversed segment and the jejunum above the proximal
anastomosis in group 3. The duration of the postprandial period without duodenal MMC
activity was significantly prolonged in groups 2 and 3. These results suggest that
the transit time and passage of intestinal contents were delayed and that the periodical
MMC was disturbed in group 3. The delay of transit time was due to prolongation of
the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum
above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical
continuity of the bowel, and discordant movements across the proximal anastomosis.
Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment
inserted after extensive small bowel resection.
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Footnotes
*Presented at the 24th Annual Meeting of the Pacific Association of Pediatric Surgeons, Hong Kong, May 20–24, 1991.
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Copyright
© 1992 W.B. Saunders Company. All right reserved. Published by Elsevier Inc.
