Jingliang Yan, MD, PhD1, Andrew Strong, MD1, Gautam Sharma, MD1, Scott Gabbard, MD2, John Rodriguez, MD1, Matthew Kroh, MD1. 1Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic, 2Dept. of Gastroenterology and Hepatology, Cleveland Clinic
Introduction: Scleroderma is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility. However, there is sparse literature on the ideal surgical approach due to the rarity of the disease. Tailoring surgical technique to the existing physiology of each patient is important, particularly in the setting of disease progression and failure of medical management. We aim to evaluate the perioperative and intermediate outcomes of varying surgical approaches in this challenging patient cohort.
Methods and procedures: After IRB approval, scleroderma patients undergoing fundoplication or gastric bypass for treatment of GERD after failure of medical management were identified. Demographics, perioperative data, immediate complications, symptom improvement, and pulmonary function were retrieved and analyzed.
Results: Fourteen scleroderma patients who underwent surgical treatment of GERD from 2004 to 2016 were identified. Average BMI was 26. Seven fundoplications (2 Nissens, 4 Toupets, and 1 Dor), and 7 Roux-en-Y gastric bypasses (RYGB) were performed. No 30-day mortality was observed in either group. In the fundoplication group, 1 patient suffered from a myocardial infarction postoperatively. Two patients in the group had disrupted wraps 4 and 5 years after surgery, and another patient progressed to require an esophagectomy 1 year after fundoplication. In the RYGB group, there were no reoperations. There was one death in this group not related to the surgical intervention, but from previous injury and subsequent aspiration pneumonia after lung transplantation. The patient died of sepsis from ongoing pneumonia on postoperative day 34. Median follow-up for both groups was 17 months. Of the patients who had assessment of their GERD symptoms at follow up, 80% (N=5) in the RYGB group, and 33% (N=6) in the fundoplication group reported symptom improvement or resolution. Pulmonary function was tested postoperatively in patients with concurrent interstitial lung disease. Seventy-five percent (N=4) of RYGB patients showed improvement of their PFTs (FEV1), by an average of 45%, while all of the fundoplication patients (N=3) had worse outcomes (average FEV1 decrease, 19%).
Conclusion: In this single institution series, Roux-en-Y gastric bypass appears to be a safe and therapeutic option for scleroderma patients with severe GERD and esophageal dysmotility, resulting in improvement of both GERD symptoms and pulmonary function testing.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79364
Program Number: P365
Presentation Session: Poster (Non CME)
Presentation Type: Poster