Abstract
Background
Redo fundoplication has acceptable outcomes in patients with failed previous fundoplications. However, a subset of patients require Roux-en-Y (RNY) reconstruction for symptom relief.
Aim
The aim of this study was to demonstrate safety and efficacy of RNY reconstruction for failed fundoplications.
Method
Retrospective review of data on patients who underwent short-limb RNY gastrojejunostomy (GJ) or esophagojejunostomy (EJ) between the years 2005 and 2007 was performed.
Results
Twenty-two patients underwent RNY reconstructions. Fourteen (64%) patients had one, six (27%) patients had two, and 2 (9%) patients had three previous anti-reflux procedures. RNY GJ was performed in 18 patients and EJ in four patients. Gastrectomy was performed in 13 of these patients. Seven patients (32%) had ten major or minor complications within the 30-day postoperative period, without any mortality observed. At a mean follow-up of 23 months, completed in 21 of these patients (95%), the average heartburn score was 0.38 (range, 0–2). The average regurgitation score was 0.23 (range, 0 to2) and the average dysphagia score was 0.7 (range, 0–2). The mean postoperative BMI was 25.4 compared to a preoperative BMI of 31.
Conclusion
RNY reconstruction with GJ or EJ for failed anti-reflux procedures is a safe, valid surgical option in difficult situations, where a redo fundoplication is either non-feasible or expected to fail. However, it is associated with higher morbidity.
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References
Horgan S, Pohl D, Bogetti D, Eubanks T, Pellegrini C. Failed antireflux surgery; what have we learned from reoperations? Arch Surg 1999;134:809–817.
Bais JE, Horbach JM, Masclee AA, Smout AJ, Terpstra JL, Gooszen HG. Surgical treatment for recurrent gastro-oesophageal reflux disease after failed antireflux surgery. Br J Surg 2000;87:243–249.
Iqbal A, Awad Z, Simkins J, Shah R, Haider M, Salinas V, Turaga K, Karu A, Mittal SK, Filipi CJ. Repair of 104 failed anti-reflux operations. Ann Surg 2006;244:42–51.
Ohnmacht GA, Deschamps C, Cassivi SD, Nichols FC 3rd, Allen MS, Schleck CD, Pairolero PC. Failed antireflux surgery: results after reoperation. Ann Thorac Surg 2006;81:2050–2054.
DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 1986;204:9–20.
Shirazi SS, Schulze K, Soper RT. Long-term follow-up for treatment of complicated chronic reflux esophagitis. Arch Surg 1987;122:548–552.
Stirling MC, Orringer MB. Surgical treatment after the failed antireflux operation. J Thorac Cardiovasc Surg 1986;92:667–672.
Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;223:673–685.
Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220:137–145.
Peters JH, Heimbucher J, Kauer WK, Incarbone R, Bremner CG, DeMeester TR. Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 1995;180:385–393.
Washer GF, Gear MWL, Dowling BL, Gillison EW, Royston CM, Spencer J. Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis. Br J Surg 1984;71:181–184.
Salo JA, Lempinen M, Kivilaakso E. Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication. Br J Surg 1985;72:623–625.
Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal disease following Roux-en-Y gastric bypass. Obes Surg 1997;7(6):479–484.
Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2002;16:1027–1031.
Perry Y, Courcoulas AP, Fernando HC, Buenaventura PO, McCaughan JS, Luketich JD. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS 2004;8(1):19–23.
Patterson EJ, Davis DG, Khajanchee Y, Swanström LL. Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 2003;17(10):1561–1565.
Nelson LG, Gonzalez R, Haines K, Gallagher SF, Murr MM. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg 2005;71(11):950–953.
Kent MS, Luketich JD, Irshad K, Awais O, Alvelo-Rivera M, Churilla P, Fernando HC, Landreneau RJ. Comparison of surgical approaches to recalcitrant gastroesophageal reflux disease in the patient with scleroderma. Ann Thorac Surg 2007;84:1710–1716.
DePaula AL, Hashiba K, Baffuto M, Machado CA. Laparoscopic reoperations after failed and complicated antireflux operations. Surg Endosc 1995;9:681–686.
Siewert JR, Isolauri J, Feussner H. Reoperation following failed fundoplication. World J Surg 1989;13:791–796.
Hiebert CA, O’Mara CS. The Belsey operation for hiatal hernia: a twenty year experience. Am J Surg 1979;137:532–535.
Csendes A, Bragheto I, Burdiles P, Smok G, Henriquez A, Parada F. Regression of intestinal metaplasia to cardiac or fundic mucosa in patients with Barrett’s esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion. A prospective study of 78 patients with more than 5 years of follow up. Surgery 2006;139(1):46–53.
Csendes A, Braghetto I, Burdiles P, Díaz JC, Maluenda F, Korn O. A new physiologic approach for the surgical treatment of patients with Barrett’s esophagus: technical considerations and results in 65 patients. Ann Surg 1997;226(2):123–133.
Lillemoe K. A new approach for the surgical treatment of Barrett’s esophagus. Ann Surg 1997;226(2):121–122.
Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 2007;21:1978–1984.
Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001;15:986–989.
Raftopoulos I, Awais O, Courcoulas AP, Luketich JD. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg 2004;14(10):1373–1380.
Houghton SG, Nelson LG, Swain JM, Nesset EM, Kendrick ML, Thompson GB, Murr MM, Nichols FC, Sarr MG, et al. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis 2005;1(5):475–480.
Williams VA, Watson TJ, Gellersen O, Feuerlein S, Molena D, Sillin LF, Jones C, Peters JH. Gastrectomy as a remedial operation for failed fundoplication. J Gastrointest Surg 2007;11:29–35.
Awais O, Luketich JD, Tam J, Irshad K, Schuchert MJ, Landreneau RJ, Pennathur A. Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery. Ann Thorac Surg 2008;85:1954–1961.
Acknowledgements
We thank Aikaterini A. Nella, MD for the medical illustration and Janese Gerhardt, RN for the follow-up data collection.
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Makris, K.I., Lee, T. & Mittal, S.K. Roux-en-Y Reconstruction for Failed Fundoplication. J Gastrointest Surg 13, 2226–2232 (2009). https://doi.org/10.1007/s11605-009-0994-4
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DOI: https://doi.org/10.1007/s11605-009-0994-4