Roux-en-Y Near Esophagojejunostomy for Failed Antireflux Operations: Outcomes in More Than 100 Patients

Awais, Omar; Luketich, James D.; Reddy, N. Dinesh Kumar; Bianco, Valentino; Levy, Ryan M.; Schuchert, Matthew J.; Gooding, William E.; Crist, Lawrence; Landreneau, Rodney J.; Pennathur, Arjun

doi:10.1016/j.athoracsur.2014.07.004

Cited by 23 publications

(8 citation statements)

References 36 publications

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“…Gastric bypass has long been the most effective bariatric procedure for resolving reflux disease, due to anatomical diversion of gastric acid, and is even offered as a revisional option after failed antireflux surgery. 27 These findings were confirmed in our results, with LRYGB patients experiencing the greatest resolution of GERD. RYGB was less successful than LRYGB indicating a superior effect of the laparoscopic procedure in treating reflux.…”

Section: Discussionsupporting

confidence: 88%

Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

Finley¹

2020

AOWMC

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Purpose: Several bariatric operations are utilized to treat the growing obesity epidemic. The goal of this study was to identify variations in post-operative weight loss and obesity-related co-morbidities between the most commonly performed weight loss operations. Methods: Data from 166,601 patients in the Surgical Review Corporation’s Bariatric Outcomes Longitudinal Database (BOLD) who underwent Laparoscopic Adjustable Gastric Banding (LAGB, n=67,514), Bilio-Pancreatic Diversion/Duodenal Switch (BPD/DS, n=1,673), laparoscopic (LRYGB, n=83,059) and open (RYGB, n=5,389) Roux-en-Y gastric bypass, and Laparoscopic Sleeve Gastrectomy (SG, n=8966 ) was analyzed at baseline, and at 2, 4, 6, 12, 18, and 24 months post-operatively. Weight, BMI, and 29 weight related medical conditions were analyzed. Statistics: Continuous variables were analyzed using ANOVA with treatment in the model. General Linear Models included baseline and post-operative data, modified for binomial distribution of dichotomous variables. Results: BPD/DS patients had the lowest weight at 24 months and highest resolution of hypertension, diabetes, hyperlipidemia, and asthma, but most increase in cholelithiasis, liver disease, abdominal hernias, and psychological disorders. LRYGB best treated GERD and somatic disorders. OSA and gout resolved most after SG. LAGB was least effective in weight loss and co-morbidity resolution, but least likely to develop post-op liver disease, cholelithiasis, abdominal hernias, and symptomatic abdominal skin. Conclusions: Post-operative weight loss and rates of obesity-related co-morbidities vary between LAGB, BPD/DS, RYGB, LRYGB, and SG. Knowledge of these differences can help guide the pre-operative evaluation of obese patients presenting for weight loss surgery

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Section: Discussionsupporting

confidence: 88%

Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

Finley¹

2020

AOWMC

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“…During follow-up (mean, 23.39 months), median BMI decreased from 35.0 to 27.6 (P<0.0001), and the mean dysphagia score decreased from 2.9 to 1.5 (P<0.0001). The median GERD HRQOL score, assessed in a subset of patients, was classified as excellent (21). This study not only showed that RNYNEJ is a viable and effective alternative to fundoplication in the correct setting, but also showed benefit for patients with obesity, and esophageal dysmotility.…”

Section: Commentsmentioning

confidence: 76%

Laparoscopic approaches to failed fundoplication for reflux

Tamesis¹,

Witek²,

Luketich³

et al. 2020

Shanghai Chest

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With laparoscopic primary fundoplication now a well-established treatment for gastroesophageal reflux disease (GERD), there is an increasing number of patients that are being referred for complex reoperative intervention for failed primary fundoplication. The majority of patients presenting with failed primary fundoplication can be managed non-operatively, a subset of patients will benefit from re-operative surgery. Re-operative anti-reflux surgery can usually be performed using minimally invasive techniques with good results. The key principle of re-operative surgery for failed fundoplication is establishing and restoration of normal anatomy. It is also essential to perform complete mediastinal esophageal mobilization to recognize a short esophagus, and to preserve crural integrity. The surgical options for an anti-reflux procedure include redo-fundoplication, and Roux-en-Y near esophagojejunostomy (RNYNEJ). In some instances, esophagectomy may be indicated.

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“…Median length of stay for this cohort was 6 days and there were no perioperative mortalities. 12 Regardless of the published study or the institution performing such complex redo conversion of a failed fundoplication to RNY, the outcomes have been consistently the same. Significant improvement in GERD, drop in BMI, improvement of co-morbidities with acceptable morbidity and zero mortality should be expected at high volume academic centers of excellence.…”

Section: Discussionmentioning

confidence: 98%

“…Significant perioperative morbidities reported include anastomotic leak, Roux limb obstruction, pneumonia, pulmonary embolism, and myocardial infarction. 12 Anastomotic leak can be managed either operatively or non-operatively depending on the extent of the leak. This should be assessed endoscopically and/ or with diagnostic laparoscopy or laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Role of Roux-en-Y for Remedial Anti-reflux Surgery

Agyabeng-Dadzie

Awais

2023

Foregut: The Journal of the American Foregut Society

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Initial treatment for failed anti-reflux surgery includes medical management, lifestyle changes and endoscopic dilation. Redo fundoplication may be necessary for intractability. With the effectiveness of Roux-en-Y gastric bypass for obesity, we have also noticed significant improvement in reflux, suggesting a relationship between reflux and obesity. With the ongoing obesity epidemic, we have observed a higher incidence of obese patients with failed anti-reflux surgery. In this subset of patients, Roux-en-Y is emerging as a favored surgical approach for remedial anti-reflux surgery. In this review we identify crucial factors to consider, describe our surgical technique and evaluate outcomes after conversion to Roux-en-Y.

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Roux-en-Y Near Esophagojejunostomy for Failed Antireflux Operations: Outcomes in More Than 100 Patients

Cited by 23 publications

References 36 publications

Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

Laparoscopic approaches to failed fundoplication for reflux

Role of Roux-en-Y for Remedial Anti-reflux Surgery

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