VAGOTOMY, ANTRECTOMY, AND ROUX-EN-Y DIVERSION FOR COMPLEX REOPERATIVEGASTROESOPHAGEAL REFLUX DISEASE

Objective Failure of conventional surgical therapy for treatment of pa tients with gastroesophageal reflux disease (GERD) taxes the ingenuity of the esophageal surgeon. This study defines the role of vagotomy, a ntrectomy, and Roux-en-Y diversion coupled, when necessary, with resec tion of the esophagogastric junction as an alternative to other surgic al procedures currently employed for these complicated cases. Summary Background Data Currently, the operation in question rarely is perform ed in the United States. Other procedures, such as interposition of sh ort or long segments of intestine and total esophagectomy with gastric pull-up, are preferred. However, surgeons from Scandinavia, Great Bri tain, and Europe have published widely on the subject, some even prefe rring its use as a primary procedure in GERD. Methods This report revi ews the indications and results of the operation in 36 patients who un derwent operation between January 1970 and January 1994. Follow-up eva luation was available for review in 33 patients observed from 1 to 20 years postoperatively (average, 6 2/3 years). Of these patients, 32 ha d undergone 66 previous operative procedures an the distal esophagus a nd stomach ranging from 1 to 6 per patient. There were no hospital dea ths, but complications developed in nine patients (25%); only half of these complications were major. Of patients available for follow-up, 8 5% were improved by the operation, 24 of the 33 having excellent or go od results. Conclusions The operation of vagotomy, antrectomy, and Rou x-en-Y diversion, embodying the principles of acid suppression and alk aline diversion, has proved to be a successful alternative to other op erative procedures currently favored in the United States for the trea tment of the complex reoperative patient with GERD.