F. Fekete et al., ROUX-EN-Y DUODENAL DIVERSION FOR COMPLEX GASTROESOPHAGEAL REFLUX DISEASE, Gastroenterologie clinique et biologique, 21(11), 1997, pp. 823-831
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.