Duodeno-gastro-esophageal reflux after gastric surgery: Surgical therapy and outcome in 42 consecutive patients

BACKGROUND/AIMS: Duodeno-gastro-esophageal reflux is a common event after g astric surgery and can result in severe symptoms and mucosal injury. Medica l therapy is largely ineffective. The most common remedial operation consis ts of a long isoperistaltic Roux-en-Y limb in order to shunt duodenal conte nts away from the gastric pouch and the esophagus. METHODOLOGY: Between 1980 and 1996, 42 patients underwent duodenal diversio n after gastric surgery. The presence of severe symptoms and/or endoscopic esophagitis unresponsive to medical therapy was considered an indication fo r surgery. Functional studies were performed in selected patients in an att empt to objectively document the presence of excessive duodeno-gastro-esoph ageal reflux. A 40-60cm Roux-en-Y limb was constructed in all patients. RESULTS: There was no post-operative mortality. The median follow-up was 28 months (range: 5-114). Symptoms related to delayed gastric emptying persis ted in 5 patients (11.9%). Overall, 32 patients (76%) had a Visick I-II sco re. Best results (90%) were achieved in patients with previous total gastre ctomy. CONCLUSIONS: Roux-en-Y duodenal diversion should be reserved for patients w ith intractable symptoms and documented reflux, and is mostly effective aft er total gastrectomy. Patients with a residual, stomach are less likely to benefit from the procedure, probably because an underlying motor disorder p lays a major role in the pathogenesis of the symptoms than does the reflux of duodenal contents.