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 journalArticle

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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    Makris, K. I., Panwar, A., Willer, B. L., Ali, A., Sramek, K. L., Lee, T. H., & Mittal, S. K. (2012). The role of short-limb Roux-en-Y reconstruction for failed antireflux surgery: A single-center 5-year experience. Surgical endoscopy, 26(5), 1279-1286. https://doi.org/10.1007/s00464-011-2026-1