Surgery · 2025
Roux limb revision for recalcitrant bile reflux after total gastrectomy.
СтатьяResearch Support, N.I.H., IntramuralНазвание и аннотация: Перевод пока не подготовлен
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Gallanis Amber F, Bowden Cassidy, Sharma Disha, Rodriguez Gracia Viana, Lopez Rachael, Payne Charlotte, Joyce Stacy, Broesamle Riema, Blakely Andrew M, Hernandez Jonathan M, Korman Louis, Heller Theo, Davis Jeremy L
Аннотация
BACKGROUND: Bile reflux is a postgastrectomy syndrome that impacts quality of life. Management includes lifestyle modifications and medical therapy; however, the efficacy of operative intervention for refractory bile reflux is unknown. We aimed to characterize outcomes of Roux limb lengthening for management of recalcitrant bile reflux after total gastrectomy.
METHODS: Retrospective analysis of 159 individuals with germline CDH1 mutations who underwent prophylactic total gastrectomy with Roux-en-Y reconstruction. Patient demographics, frequency of recalcitrant bile reflux, type of medical management, operative details, and clinical outcomes were measured.
RESULTS: Fourteen (8.8%, 14/159) individuals developed bile reflux recalcitrant to medical therapy after prophylactic total gastrectomy and elected for operative Roux limb lengthening of 20-25 cm. Median time from prophylactic total gastrectomy to Roux limb revision was 2.6 years (interquartile range, 2.1-2.9). After revisional surgery, all patients self-reported improvement in bile reflux symptoms. Post-Roux limb revision, almost all (86%, 12/14) patients reported rare or no bile reflux symptoms. Bile reflux severity scores improved to no symptoms in 3 patients (21%), followed by mild (50%, 7/14) or moderate (29%, 4/14) symptoms after Roux limb revision. All individuals (100%, 14/14) who underwent Roux limb revision reported "major improvement" in bile reflux symptoms with a median follow-up of 16 months (interquartile range, 7.5-21.5). Most patients regained weight post-Roux limb revision (+3.3 kg, standard deviation 4.7, P = .02) with a mean percentage weight gain of 5.9% (standard deviation, 7.4). There were no intraoperative or postoperative complications with revisional surgery.
CONCLUSION: Roux limb revision is effective for management of recalcitrant bile reflux. Additional study to identify potential risk factors for bile reflux after total gastrectomy is warranted.
METHODS: Retrospective analysis of 159 individuals with germline CDH1 mutations who underwent prophylactic total gastrectomy with Roux-en-Y reconstruction. Patient demographics, frequency of recalcitrant bile reflux, type of medical management, operative details, and clinical outcomes were measured.
RESULTS: Fourteen (8.8%, 14/159) individuals developed bile reflux recalcitrant to medical therapy after prophylactic total gastrectomy and elected for operative Roux limb lengthening of 20-25 cm. Median time from prophylactic total gastrectomy to Roux limb revision was 2.6 years (interquartile range, 2.1-2.9). After revisional surgery, all patients self-reported improvement in bile reflux symptoms. Post-Roux limb revision, almost all (86%, 12/14) patients reported rare or no bile reflux symptoms. Bile reflux severity scores improved to no symptoms in 3 patients (21%), followed by mild (50%, 7/14) or moderate (29%, 4/14) symptoms after Roux limb revision. All individuals (100%, 14/14) who underwent Roux limb revision reported "major improvement" in bile reflux symptoms with a median follow-up of 16 months (interquartile range, 7.5-21.5). Most patients regained weight post-Roux limb revision (+3.3 kg, standard deviation 4.7, P = .02) with a mean percentage weight gain of 5.9% (standard deviation, 7.4). There were no intraoperative or postoperative complications with revisional surgery.
CONCLUSION: Roux limb revision is effective for management of recalcitrant bile reflux. Additional study to identify potential risk factors for bile reflux after total gastrectomy is warranted.