To the Editor.—In regard to the article by Miedema and Kelly1 in the March 1992 issue of the Archives, it should be made clear that humans were created with a Y ("Roux") juncture of the fused common bile and pancreatic duct, which jointly discharge their "irritating alkaline contents" (hormones, enzymes, and secretagogues) into the second portion of the duodenum. Reflux into the organs of origin, the acid-free gastric remnant, and the acid-gastric reservoir is inhibited by two independently and synergistically competent mechanisms, the sphincter of Oddi and the pylorus. Surgeons have deferred from respecting the latter force since it was first resected in 1881, all the while displaying much concern for such elements as sphincters and cardiac, anal, and ileocecal valves.
The authors stated that "After a 12-hour fast the dogs are placed in a supine position...." To equate ingress into and egress from the stomach of the
FRANKEL LA. Roux Stasis Syndrome: Treatment by Pacing and Prevention by Use of an 'Uncut' Roux Limb. Arch Surg. 1992;127(9):1135-1136. doi:10.1001/archsurg.1992.01420090147024