• Journal of Gastric Cancer
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• v.1 no.1
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• pp.38-43
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• 2001

Purpose: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. Materials and Methods: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at $7\∼12,\;13\~18,\;19\~24,\;25\~30$, and $31\∼36$ months. Results: According to the criteria, the Roux stasis syndrome occurred in 40.0$\%$ of the patients at 7$\∼$12 months, 33.3$\%$ at $13\∼19$ months, $35.3\%$ at $19\∼24$ months, $32.0\%$ at $25\~30$ months, and $33.3\%$ at $31\∼36$ months after a conventional Roux-en-Y operation. The syndrome occurred in $22.6\%$ of the patients at $7\∼12$ months, $15.2\%$ at $13\∼18$ months, $17.1\%$ at $19\∼24$ months, $19.2\%$ at $25\∼30$ months, and $20\%$ at $31\∼36$ months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.215-222
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• 2009

Purpose: Billroth II gastroenterostomy is a typical reconstruction method after distal gastrectomy for gastric carcinoma, but it has problems, especially frequent reflux esophagitis. Various methods have been tried to address this problem. Among them are Braun enteroenterostomy and Roux-en-Y gastroenterostomy, which are performed separately according to the size of the gastric remnant. The aim of our study was to determine whether these applications are compatible. Materials and Methods: Between September 2003 and April 2007, we performed Roux-en-Y gastroenterostomy operations (14 patients) when the size of the gastric remnant was <10%, Braun enteroenterostomy (17 patients) when the size was between 10 and 20%, and Billroth II gastroenterostomy (14 patients) when the size was between 20 and 40% after subtotal gastrectomy for gastric cancer by a single surgeon at our hospital. We analyzed the results of each treatment. We evaluated the symptoms and endoscopic findings using questionnaires and hospital records. To evaluate nutritional states, we reviewed albumin and hemoglobin levels and body weight changes. Results: All operations were performed safely mortality was 0% and postoperative complications were 8.9%. On endoscopy, reflux gastritis was observed to occur in 7.63%, 18.65% and 40.0%, respectively, of patients who had undergone Roux-en-Y, Braun and Billroth II operations (P=0.13). Reflux esophagitis was observed in 1 patient in the Roux-en-Y group and 1 patient in the Braun group. Endoscopic gastrostasis was observed in 2 patients in the Roux-en-Y group, one of which was thought to cause reflux esophagitis. Patients in the Roux-en-Y group and Braun groups ingested a lower volume of food than did those in the Billroth II group (respectively, 7.1%, 0.0% and 28.7%) and complained less of postprandial discomforts (respectively, 14.3%, 23.5% and 57.1%) and reflux symptoms (respectively 0.0%, 11.8% and 42.9%). Conclusion: The application of Braun enteroenterostomy and Roux-en-Y gastroenterostomy to the small gastric remnant may be effective for reducing reflux symptoms and abdominal discomfort after distal gastric resection. We recommend Roux-en-Y gastroenterostomy when the size of the gastric remnant is <10%, and Braun anastomosis in the others. It will need to be determined which reconstructive procedure is better for many different conditions.

• Journal of Gastric Cancer
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• v.11 no.4
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• pp.219-224
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• 2011

Purpose: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. Materials and Methods: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. Results: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). Conclusions: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.

• Culinary science and hospitality research
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• v.15 no.2
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• pp.150-160
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• 2009

This study analyzed the quality characteristics of demi-glace sauce with different addition of roux which is usually used as a thickener. The trust level and acceptability for commercial demi-glace sauce were surveyed in order to draw the visual idea and direction for the development of large scale commercial production of demi-glace sauce. Also, the optimal level of salt and roux content in the sauce was determined with various cooking conditions. As the roux content increased, the color became light and the viscosity of the sauce increased while pH, salinity and brix were not affected much by amount of roux. The professional chefs as well as general sensory panel preferred the demi-glace sauce prepared with 9% roux. To sum up, it can be claimed that the optimal conditions established in this study for commercial production of demi-glace sauce ensure the desired quality and economic feasibility.

• Culinary science and hospitality research
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• v.13 no.3
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• pp.44-53
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• 2007

This study investigated the utilization of pumpkin cream soup mixture of pumpkin P1(sweet pumpkin 25%, pumpkin 75%), and S1(rice flour 100%) and S3(rice powder 50%, glutinous rice powder 50%) as thickening agents showed highest preference for pumpkin cream soup. Rice powder was used in pumpkin cream soup as a thickening agent. Hunter's color marked the lowest value in using group of flour roux, in contrast with the highest value in using glutinous rice powder roux. The results of viscosity were diverse according to the condition of relationships between the percentage of contents flour, rice and glutinous rice control. For the sensory evaluation, parameters such as appearance, color, viscosity and savory taste increased significantly from the control at glutinous rice roux, and overall acceptability marked the lowest result in flour roux control.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.139-145
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• 2007

Purpose: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. Materials and Methods: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. Results: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. Conclusion: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.

• Culinary science and hospitality research
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• v.20 no.3
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• pp.148-160
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• 2014

This study was performed to find out the optimum condition of a thickening agent for brown sauce. Four thickening agents of non-glutinous rice, glutinous rice and potato starch, and roux as control thickeners were tested with various concentrations of each thickener to investigate the quality characteristics of brown sauce samples. The moisture contents of the brown sauce samples thickened with non-glutinous rice, glutinous rice and potato starch showed higher than that of the brown sauce samples thickened with roux. The brown sauce samples thickened with non-glutinous rice and potato starch had higher viscosity than the samples with glutinous rice and roux. The brown sauce with roux showed the highest on Hunter's color L and b value and the brown sauce with non-glutinous rice showed the highest a value. The brown sauce samples with 11% of roux, 11% of non-glutinous rice powder, 12% of glutinous rice powder and 6% of potato starch showed significantly higher scores in the acceptance test. The brown sauce with 6% potato starch resulted in the highest score in brown color, gloss, and transparency, and the brown sauce with 11% of roux showed the highest roast smell. The brown sauces with 6% potato starch and 11% of roux showed higher viscosity than the samples with 11% of non-glutinous rice and 12% of glutinous rice.

• Culinary science and hospitality research
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• v.22 no.7
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• pp.100-111
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• 2016

Tomato sauce were prepared with five different thickening agents including roux (TR), non-glutinous rice powder (TN), glutinous rice powder (TG), potato starch (TP) and tapioca starch (TT) to examine proximate composition (moisture, carbohydrate, crude protein, crude fat, crude ash, crude ash), calorie, color value, pH, salinity, $^{\circ}Brix$, reducing sugar, viscosity and sensory test (attribute difference, acceptance). The results were as follows: Moisture, carbohydrate content were the lowest while crude fat and calorie were the highest in TR (roux). On the other hand, moisture, carbohydrate content were the highest while crude protein, crude fat and calorie were the lowest in TP (potato starch) and TT (tapioca starch). Using potato starch and tapioca starch are supposed to be prepared low-fat, low-calorie tomato sauce. L value was the highest in TN (non-glutinous rice powder), a value was the highest in TP (potato starch), b values was the highest in TR (roux). pH of tomato sauce showed a range of 5.24 to 5.39. TG (glutinous rice powder) was the highest and TT (tapioca starch) was the lowest in pH. TP (potato starch) was the highest salinity, reducing sugar was the lowest. TG (glutinous rice powder) was the lowest salinity, $^{\circ}Brix$ was the highest. And TR (roux) was the lowest $^{\circ}Brix$, reducing sugar was the highest. In viscosity, TG (glutinous rice powder) was the highest and TT (tapioca starch) was the lowest. The attribute difference test results was the highest in gloss, color intensity, tomato odor, tomato taste, pure taste in TT (tapioca starch) and savory taste, oily taste, thickness, residue was the highest in TR (roux). The preference test results reveal that the appearance, flavor, taste, texture and overall acceptance level was the highest in TP (potato starch) and TT (tapioca starch). The results of this study, tomato sauce prepared potato starch and tapioca starch instead of the traditional roux was higher in sensory acceptability. Recently, people is avoided high-fat and high-calorie foods, and potato starch and tapioca starch are confirmed that the tomato sauce can be made of a low-fat and low-calorie.

• Journal of Gastric Cancer
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• v.20 no.3
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• pp.337-343
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• 2020

Distal gastrectomy with Billroth I or II reconstruction may cause duodenogastroesophageal reflux (DGER), thereby resulting in digestive or respiratory symptoms. The mainstay of treatment is medication with proton pump inhibitors. However, these drugs may have limited effects in DGER. Laparoscopic fundoplication has been proven to be highly effective in treating gastroesophageal reflux disease (GERD), but it cannot be performed optimally for GERD that develops after gastrectomy. We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy.

• Journal of Gastric Cancer
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• v.19 no.1
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• pp.132-137
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• 2019

The occurrence of hiatal hernia after total gastrectomy with Roux-en-Y reconstruction is rare. We report the case of a 76-year-old man who presented with dyspnea, vomiting, and fever around 8 days after total gastrectomy with Roux-en-Y reconstruction. Abdominal computed tomography revealed a hiatal hernia containing part of the small intestine in the left thoracic cavity. Emergent reduction and repair of the hiatal hernia were performed later. Operative findings revealed that the Roux limb was incarcerated in the left pleural cavity. Esophagojejunostomy leakage, perforation of the small intestine with transient ischemic change, and pyothorax were also found. Thus, feeding jejunostomy, thoracoscopic decortication, and diversion T-tube esophagostomy were performed. Considering that the main cause of hiatal hernia is blunt dissection with division of the phrenoesophageal membrane, approximating the crus with 1 or 2 figure-8 sutures, according to the size of the defect, to prevent the incidence of hiatal hernia after total gastrectomy may be performed.