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Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery.
Ann Thorac Surg. 2008 Jun; 85(6):1954-9; discussion 1959-61.AT

Abstract

BACKGROUND

Intractable gastroesophageal reflux disease (GERD) after prior antireflux operation presents a difficult challenge. Our objective was to investigate the role of Roux-en-Y near esophagojejunostomy (RNYNEJ) in the management of intractable reflux symptoms after prior antireflux surgery.

METHODS

Between June 2000 and October 2005, 25 patients with GERD after antireflux surgery underwent RNYNEJ. The endpoints evaluated were improvement in GERD symptoms using the GERD-Health Related Quality of Life (HRQL) scale, overall patient satisfaction, overall patient weight loss, and improvement of comorbid conditions.

RESULTS

There were 4 men and 21 women (mean age 51 years; range, 35 to 74). Seventy two percent had a body mass index (BMI) greater than 30. Forty-four percent had more than one antireflux surgery and 40% had a previous Collis gastroplasty. The perioperative mortality was 0%. Six patients (24%) developed major postoperative complications, including anastomotic leak (n = 2) and Roux-limb obstruction (n = 1). The median length of stay was 6 days. Eighty percent of the patients reported satisfaction at mean follow-up time of 16.5 months. Their BMI reduced from 35.8 to 27.7 (p < 0.001). Seventy three percent of comorbid conditions were improved and the GERD HRQL score improved from 29.9 to 7.3 (p < 0.001).

CONCLUSIONS

The RNYNEJ for persistent GERD after prior antireflux surgery is technically challenging with significant morbidity. However, the majority of the patients reported satisfaction with significant improvement in symptoms. Many patients had associated benefits of weight loss and improvement in comorbid conditions. Roux-en-Y near esophagojejunostomy should be considered as an important option for the treatment of intractable GERD after prior antireflux surgery, particularly in the obese.

Authors+Show Affiliations

The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18498802

Citation

Awais, Omar, et al. "Roux-en-Y Near Esophagojejunostomy for Intractable Gastroesophageal Reflux After Antireflux Surgery." The Annals of Thoracic Surgery, vol. 85, no. 6, 2008, pp. 1954-9; discussion 1959-61.
Awais O, Luketich JD, Tam J, et al. Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery. Ann Thorac Surg. 2008;85(6):1954-9; discussion 1959-61.
Awais, O., Luketich, J. D., Tam, J., Irshad, K., Schuchert, M. J., Landreneau, R. J., & Pennathur, A. (2008). Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery. The Annals of Thoracic Surgery, 85(6), 1954-9; discussion 1959-61. https://doi.org/10.1016/j.athoracsur.2008.01.072
Awais O, et al. Roux-en-Y Near Esophagojejunostomy for Intractable Gastroesophageal Reflux After Antireflux Surgery. Ann Thorac Surg. 2008;85(6):1954-9; discussion 1959-61. PubMed PMID: 18498802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery. AU - Awais,Omar, AU - Luketich,James D, AU - Tam,John, AU - Irshad,Kashif, AU - Schuchert,Matthew J, AU - Landreneau,Rodney J, AU - Pennathur,Arjun, PY - 2007/02/06/received PY - 2008/01/22/revised PY - 2008/01/23/accepted PY - 2008/5/24/pubmed PY - 2008/6/13/medline PY - 2008/5/24/entrez SP - 1954-9; discussion 1959-61 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 85 IS - 6 N2 - BACKGROUND: Intractable gastroesophageal reflux disease (GERD) after prior antireflux operation presents a difficult challenge. Our objective was to investigate the role of Roux-en-Y near esophagojejunostomy (RNYNEJ) in the management of intractable reflux symptoms after prior antireflux surgery. METHODS: Between June 2000 and October 2005, 25 patients with GERD after antireflux surgery underwent RNYNEJ. The endpoints evaluated were improvement in GERD symptoms using the GERD-Health Related Quality of Life (HRQL) scale, overall patient satisfaction, overall patient weight loss, and improvement of comorbid conditions. RESULTS: There were 4 men and 21 women (mean age 51 years; range, 35 to 74). Seventy two percent had a body mass index (BMI) greater than 30. Forty-four percent had more than one antireflux surgery and 40% had a previous Collis gastroplasty. The perioperative mortality was 0%. Six patients (24%) developed major postoperative complications, including anastomotic leak (n = 2) and Roux-limb obstruction (n = 1). The median length of stay was 6 days. Eighty percent of the patients reported satisfaction at mean follow-up time of 16.5 months. Their BMI reduced from 35.8 to 27.7 (p < 0.001). Seventy three percent of comorbid conditions were improved and the GERD HRQL score improved from 29.9 to 7.3 (p < 0.001). CONCLUSIONS: The RNYNEJ for persistent GERD after prior antireflux surgery is technically challenging with significant morbidity. However, the majority of the patients reported satisfaction with significant improvement in symptoms. Many patients had associated benefits of weight loss and improvement in comorbid conditions. Roux-en-Y near esophagojejunostomy should be considered as an important option for the treatment of intractable GERD after prior antireflux surgery, particularly in the obese. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18498802/Roux_en_Y_near_esophagojejunostomy_for_intractable_gastroesophageal_reflux_after_antireflux_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)00213-0 DB - PRIME DP - Unbound Medicine ER -