Bile Diverting Operations in the Management of Reflux Esophagitis
After several failed procedures for gastroesophageal reflux, one may elect to attack the esophagogastric junction another time by performing either a Collis—Nissen operation or a jejunal interposition procedure. If the patient is a poor-risk candidate for a formidable repeat dissection in the region of the esophagogastric junction, or if the technical difficulties are overwhelming, a possible alternative is a distal gastrectomy combined with a Roux-Y gastrojejunostomy. In 1970 Payne reported 15 patients who were suffering from “permanent incompetence of the cardia” and who were treated by vagotomy, hemigastrectomy, and Roux-Y gastrojejunostomy. All had severe esophagitis and six of the patients had serious strictures. Three patients suffered from achalasia and two from scleroderma of the esophagus. All of the patients had satisfactory results, although long-term followup has not been reported. Similar results were reported by Royston, Dowling, and Spencer in a series of eight patients, six of whom had undergone multiple previous operations at the esophagogastric junction. These authors stated that “none of the patients had any heartburn from the day of operation onwards.” These good results persisted during a followup period of 11–20 months.
KeywordsGastroesophageal Reflux Reflux Esophagitis Gastric Pouch Esophagogastric Junction Interrupted Suture
Unable to display preview. Download preview PDF.
- Smith J, Payne WS (1975) Surgical technique for management of reflux esophagitis after esophagogastrectomy for malignancy. Further application of Roux-en-Y principle. Mayo Clin Proc 50: 588Google Scholar