Chapter 56 Teaching Visual: The Roux-en-Y Limb

Objectives

• Draw a Roux-en-Y limb and discuss its applications in abdominal surgery.

• Draw a Roux-en-Y limb for your patient in the context of describing gastric bypass.

Medical Knowledge

Note points A, B, and C in the drawing on the left in Figure 56-1. To create a Roux-en-Y limb, cut the jejunem at the line between A and B. “Pull up” point B of the mobile jejunem as shown in the figure on the right.

Figure 56-1 The Roux-en-Y limb. The arrows indicate the direction of peristalsis.

The green arrows demonstrate the normal food stream. Note that in the Roux-en-Y limb, point B to point C is now out of the food stream, yet the limb still has antegrade peristalsis (red arrows).

This makes the Roux-en-Y limb a very valuable tool, which (like a vacuum cleaner) can collect secretions and drainage from a proximal source and deliver it distally.

After you master (and can draw) a Roux-en-Y limb, study some of its applications on the following pages.

The patient in Figure 56-2A, for example, has a Klatskin tumor, a cholangiocarcinoma at the confluence of the right and left hepatic ducts. Though the bile ducts could be sewn into a loop of jejunem, this would allow the food stream to pass too closely to the biliary tree and runs the risk of ascending cholangitis. A Roux-en-Y hepaticojejunostomy, being isolated from the food stream, solves this problem.