ROUX-EN-Y DUODENAL DIVERSION FOR COMPLEX GASTROESOPHAGEAL REFLUX DISEASE

Aims of the study - The aims of this study was to report the results o f total duodenal diversion in patients with complex peptic esophagitis (peptic stenosis, acquired short esophagus, columnar lined esophagus, previous surgery). Patients - Methods. - Total duodenal diversion has been performed in 107 patients with complex peptic esophagitis. The s tandard procedure - including a troncular vagotomy, an antrectomy and a 70 cm Roux-en-Y gastro-jejunostomy - was used in 68 cases (64 %). Te chnical adjustments were necessary in the 39 others patients. Results. - Two patients (1,8 %) died postoperatively. Permanent healing of eso phagitis was observed within 3 months in 88 % of patients. Esophagitis healed in all patients operated with the standard technique. Three ho urs postprandial pH-monitoring was normal postoperatively in 92 % of p atients. Four anastomotic ulcers occurred in patients who did not have vagotomy. Among patients with columnar lined esophagus, one complete and six partial regressions were observed; no malignant degeneration w as observed with a 210-patient-year follow-up. Among the 39 peptic ste noses, all except one (2.6 %) resolved. Functional disorders occurred in 27 % of patients within the first postoperative months; these disor ders persisted in 14 % of patients (Visick III or IV) after 3 years. T he main disorders (dumping syndrome, anastomotic ulcer diarrhea) were observed when a two-thirds distal gastrectomy has been performed to av oid the dangerous completion of vagotomy after a previous Heller's myo tomy. Conclusion. - These results suggest that total duodenal diversio n is a suitable treatment of complex peptic esophagitis.