Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication

Abstract

The results of partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication in six patients were analysed. There were no postoperative deaths. Postoperative complications (pneumonia and atelectases, postoperative ileus) developed in three patients. The results were evaluated by clinical and endoscopic examination 1 to 3.5 years after the operation. Clear clinical and endoscopic improvement was observed in five of the six patients. In the remaining patient the procedure failed to prevent progression of the oesophagitis with development of a Barrett's oesophagus. The results suggest that a partial gastrectomy with Roux-en-Y reconstruction is an effective and safe procedure in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication.

The role of short-limb Roux-en-Y reconstruction for failed antireflux surgery: a single-center 5-year experience

“…The newly created fundoplication may replicate the original configuration (if the previous failure was purely technical) or may involve a variation (i.e., partial fundoplication, should esophageal dysmotility coexist). Diversion of the main part of the stomach in the form of RNY reconstruction (GJ or EJ) is a recognized alternative strategy, and may be considered when a new fundoplication is not technically feasible or is expected to produce suboptimal results [15,[19][20][21]. In certain situations, esophagectomy is the only option for end-stage esophageal disease [27].…”

“…Good outcomes have been reported [18][19][20][21]. Previously, we presented our initial experience with RNY reconstruction for failed fundoplication with at least 1-year follow-up [22].…”

Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case–control study

“…Patients who underwent this procedure for indications other than obesity were given a larger proximal gastric pouch (roughly 1/3 of the total stomach volume) and a shorter Roux limb (50 cm). Gastrectomy with Rouxen-Y reconstruction has been used as an antireflux procedure before [22,23]. The Roux-en-Y gastric bypass (with the distal stomach left in situ) has also been shown to be an effective surgical treatment for GERD in obese patients [24].…”

Clinical and Laboratory Characteristics and Surgical Alternatives in Patients with Postoperative Recurrent Reflux Esophagitis

“…For patients with severe recurrent reflux esophagitis, other authors have suggested performing sub total gastrectomy with Y-en-Roux diversion with or with out recalibration in order to prevent acid and alkaline reflux [30][31][32][33][34][35][36]. Recently we emphasized these indications for this procedure in agreement with other previous publi cations [30][31][32][33][34][35][36], In fact, our early clinical results agree with this hypoth esis because the best results were obtained in patients sub mitted to this type of operation. We think that esophagec tomy with esophageal replacement is only indicated in cases with a critically damaged esophagus (long and criti-cal strictures, or penetrating esophageal ulcer, severe mo tility disorders).…”