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To the Editor.—The experimental model presented by Miedema and Kelly1 in the March 1992 issue of the Archives has been described recently in clinical use at least twice.2,3 Figure 1 in the article by Miedema and Kelly maps so perfectly on a published figure3 that it seems criminal to reproduce it without appropriate recognition. Dr Kelly has, in fact, provided further insight into the Letton-Q procedure, formulated by A. Hamblin Letton of Atlanta, Ga. (Ironically, a founding brother of Dr Kelly's institution, Dr William Mayo, promoted a somewhat similar operation,4 and was equally overlooked.)
Please indulge two important considerations. Placement of staples across the small bowel, effective for hemostasis, would be expected to interrupt any physiologic myoneural continuity by crush injury. However, orderly peristalsis is preserved. Is it possible that functional, smooth-muscle/neural-tissue continuity is not required? Perhaps the migrating myoelectric complex is harbored in part
MERRILL JR. Concerning the Letton-Q 'Uncut' Roux Limb. Arch Surg. 1992;127(9):1135. doi:10.1001/archsurg.1992.01420090147022