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

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/m(2) 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.