VALUE OF DUODENAL DIVERSION IN THE TREATMENT OF REFLUX ESOPHAGITIS INSCLERODERMA

Between 1985 and 1990, six patients were operated on using duodenal di version for reflux esophagitis with scleroderma. Duodenal diversion wa s performed twice as initial procedure and 4 times as treatment of uns uccessful antireflux procedure performed ten years previously. Duodena l diversion was associated with truncal vagotomy. In cases of reoperat ion the initial reconstruction procedure was removed. An esophageal st ricture was resected in one case. One patient with previous truncal va gotomy and pyloroplasty underwent supra papillary diversion. There was no postoperative death. The mean follow-up was 28 months with one pat ient lost to follow-up. For 4 patients, the postoperative weight gain was 10 per cent. Abnormalities of lower esophageal motility in sclerod erma account for the poor results after classical antireflux procedure s. In these cases duodenal diversion is indicated as primary treatment . In cases of reoperation removal of the initial anti-reflux device is required in association with duodenal diversion.