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

Konstantinos I. Makris, Aru Panwar, Brittany L. Willer, Anah Ali, Katherine L. Sramek, Tommy H. Lee, Sumeet K. Mittal

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Introduction Revisionary fundoplication is the mainstay of treatment for failed previous fundoplication, but is not always feasible. We report our experience with use of short-limb Roux-en-Y (RNY) reconstruction for failed antireflux procedures. Methods Prospectively collected data were retrospectively analyzed for morbidity, mortality, pre- and postprocedure symptom scores (scale 0-3), body mass index (BMI), and patient satisfaction (scale 1-10). Results Seventy-two patients with 1-4 (median 1) previous antireflux procedures underwent RNY reconstruction, either to gastric pouch (n = 64) or to the esophagus (n = 8). There were 37 laparoscopic, 24 open abdominal, and two combined thoracic-abdominal procedures. Nine additional patients underwent conversion from laparoscopy to open surgery. Mean follow-up of 20.7 months (±12.9 months) was available in 63 (88%) patients. The overall median scores for heartburn, regurgitation, dysphagia, chest pain, and nausea were 0 or 1. There were 72 major and minor complications noted that affected 33 (46%) patients, with no in-hospital or 30-day mortality observed. The most common complications were anastomotic strictures, bowel obstructions, respiratory complications, and dumping. Mean postoperative BMI was 24.6 (±4.4) kg/m2 compared with preoperative BMI of 31.4 (±6.1) kg/m 2. Mean reported satisfaction score was 8.2 (±2.1), and 89% of the patients would recommend the procedure to a friend. Pre- and postoperative symptoms could be compared in 57 patients, and significant decrease in median symptom scores for heartburn (2-0, P < 0.05), regurgitation (1-0, P < 0.05), and dysphagia (2-0, P < 0.05) was confirmed. There was an increase in reported nausea (0-1, P < 0.05). Conclusions Short-limb RNY reconstruction is an effective remedial procedure for a subset of patients with failed antireflux surgery, but morbidity is significant.

Original languageEnglish (US)
Pages (from-to)1279-1286
Number of pages8
JournalSurgical endoscopy
Volume26
Issue number5
DOIs
StatePublished - May 2012

Keywords

  • Clinical paper
  • Digestive
  • Esophageal
  • GORD/GERD

ASJC Scopus subject areas

  • Surgery

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