The Y anastomosis of César Roux.

RYA was designed to avoid biliary reflux, which complicated earlier forms of gastrojejunostomy. The emerging popularity of the procedure was squelched by the frequent complication of gastrojejunal stomal ulceration. RYA returned from surgical oblivion after World War II in its use in replacing the esophagus and stomach. It is now commonly used to drain other organs, mainly the biliary system, and in various remedial operations for complications from gastrectomy. Conversion to RYA is efficacious for the treatment of inflammation of the stomach and esophagus caused by alkaline reflux. The main complication of RYA is Roux Y syndrome, secondary to gastric or efferent jejunal stasis, or both. Peptic ulceration is much less a problem since the advent of vagotomy. Better understanding of the physiologic characteristics of various forms of RYA should soon better define the limits of its clinical application.