Preservation of normal gastric emptying following gastric surgery by use of a muscle bridge

BACKGROUND: Maintenance of descending antral intramural pathways may be important in normal functioning of the pylorus after pylorus-preserving gastrectomy. METHODS: We examined the effect of a 1-cm bridge of muscle as a means of maintaining pyloric connection to antral intramural motor control pathways in 10 pigs. Antropyloroduodenal pressures and transpyloric flow were measured during gastric emptying of saline before and after either total or subtotal transection and reanastomosis of antrum. RESULTS: Complete antral transection shortened the time interval between antral and subsequent pyloric lumen occlusion, significantly reducing total gastric emptying and volume of transpyloric flow pulses. Subtotal transection maintained pre-transection timing and was associated with normal patterns of transpyloric flow and emptying. CONCLUSIONS: Our results indicate that a muscle bridge is capable of maintaining normal gastric emptying and the coordination of antral with pyloric contractions. We propose that antropyloric coordination is maintained by transmission of neural signals through the muscle bridge.