K I Makris, MD, A Panwar, MD, A Ali, BS, B Willer, MD, T H Lee, MD, S K Mittal, MD. Department of surgery, Creighton University, Omaha, Nebraska
Introduction: The aim of our study is to demonstrate the safety and efficacy of short-limb Roux-en-Y (SLRNY) reconstruction for failed anti-reflux procedures.
Methods: Prospectively collected data was retrospectively analyzed for morbidity, mortality, pre- and post- procedure symptom scores (scale 0-3) and BMI, along with patient satisfaction (scale 1-10).
Results: 72 patients with one to four (mean 1.45) previous anti-reflux procedures underwent SLRNY reconstruction either to gastric pouch (n=64) or to the esophagus (n=8). There were 37 laparoscopic, 24 open abdominal and 2 combined thoracic and abdominal procedures. Nine additional patients underwent conversion from laparoscopy to open surgery. There were 43 complications in 19 (26%) patients with no in-hospital or 30-day mortality.
A mean follow-up of 22 months (range 6- 60) was available in 56 (78%) patients. There was significant decrease in mean symptom scores for heartburn (1.61 to 0.57, p<0.0001), regurgitation (1.16 to 0.48, p=0.001), and dysphagia (1.34 to 0.75, p=0.009). Reduction in reported chest pain (0.77 to 0.48, p=0.14) was not significant. There was an increase in reported nausea (0.16 to 0.75, p=0.0002). Bothersome diarrhea and constipation was reported by 4 (7.4%) patients each. There have been 5 long term complications attributable to reconstruction noted in 3 patients (3 internal hernias, one marginal ulcer perforation and one gastric remnant perforation). Mean post-operative BMI was 25.1 (18.1 to 36.8) compared to pre-operative BMI of 31 (19.1 – 49.3). Mean reported satisfaction score was 8.1.
Conclusions: SLRNY reconstruction is a safe and effective remedial procedure for a subset of patients with failed anti-reflux surgery.
Program Number: S014