Top

Journal of Gastrointestinal Surgery

Published in:

01-12-2009 | Original Article

Roux-en-Y Reconstruction for Failed Fundoplication

Authors: Konstantinos I. Makris, Tommy Lee, Sumeet K. Mittal

Published in: Journal of Gastrointestinal Surgery | Issue 12/2009

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.

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

Shirazi SS, Schulze K, Soper RT. Long-term follow-up for treatment of complicated chronic reflux esophagitis. Arch Surg 1987;122:548–552.PubMed

Stirling MC, Orringer MB. Surgical treatment after the failed antireflux operation. J Thorac Cardiovasc Surg 1986;92:667–672.PubMed

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.CrossRefPubMed

Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220:137–145.CrossRefPubMed

10.

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.PubMed

11.

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.CrossRefPubMed

12.

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.CrossRefPubMed

13.

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.CrossRefPubMed

14.

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.CrossRefPubMed

15.

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.PubMed

16.

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.CrossRefPubMed

17.

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.PubMed

18.

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.CrossRefPubMed

19.

DePaula AL, Hashiba K, Baffuto M, Machado CA. Laparoscopic reoperations after failed and complicated antireflux operations. Surg Endosc 1995;9:681–686.CrossRefPubMed

20.

Siewert JR, Isolauri J, Feussner H. Reoperation following failed fundoplication. World J Surg 1989;13:791–796.CrossRefPubMed

21.

Hiebert CA, O’Mara CS. The Belsey operation for hiatal hernia: a twenty year experience. Am J Surg 1979;137:532–535.CrossRefPubMed

22.

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.CrossRefPubMed

23.

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.CrossRefPubMed

24.

Lillemoe K. A new approach for the surgical treatment of Barrett’s esophagus. Ann Surg 1997;226(2):121–122.CrossRefPubMed

25.

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.CrossRefPubMed

26.

Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001;15:986–989.CrossRefPubMed

27.

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.CrossRefPubMed

28.

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.CrossRefPubMed

29.

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.CrossRefPubMed

30.

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.CrossRefPubMed

Title: Roux-en-Y Reconstruction for Failed Fundoplication
Authors: Konstantinos I. Makris
Tommy Lee
Sumeet K. Mittal
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0994-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Roux-en-Y Reconstruction for Failed Fundoplication

Abstract

Background

Aim

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2009

The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–2006

Selective Management of Patients with Acute Biliary Pancreatitis

Laparoscopic versus Open Liver Resection: A Matched-Pair Case Control Study

Perioperative Risk Assessment for Hepatocellular Carcinoma by Using the MELD Score

Right Colonic Perforation in an Asian Population: Predictors of Morbidity and Mortality

Rectal Distensibility and Symptoms After Stapled and Milligan–Morgan Operation for Hemorrhoids