Roux-en-Y Reconstruction for Failed Fundoplication

Abstract

RNY reconstruction with GJ or EJ for failed anti-reflux procedures is a safe, valid surgical option in difficult situations, where a redo fundoplication is either non-feasible or expected to fail. However, it is associated with higher morbidity.

Outcomes of surgical management of symptomatic large recurrent hiatus hernia

“…We have previously reported less than satisfactory outcomes in patients undergoing redo Collis fundoplication, especially in presence of decreased esophageal motility [18]. We have increasingly and successfully employed RNY reconstruction in a larger number of reoperative procedures [19][20][21]. This study clearly shows that patients with short esophagus and large recurrent hiatus hernia report significantly better results with RNY reconstruction compared with redo Collis gastroplasty.…”

Endoscopic assessment of failed fundoplication: a case for standardization

“…Reoperative antireflux surgery is a complicated and technically challenging procedure associated with high rates of morbidity (4-40%) and mortality (0-4.9%) [6,[19][20][21][22]. Patients being evaluated for reoperation usually undergo upright barium esophagography, esophagogastroduodenoscopy (EGD), esophageal manometry, 24-h pH monitoring, and a nuclear medicine gastric-emptying study [23].…”

Reoperative antireflux surgery for dysphagia

“…Potential explanations for this include creation of a neoesophagus, which is immotile, and placement of acid-producing cells above the fundoplication [34,35]. Alternate solutions exist such as conversion to Roux-en-Y reconstruction, which is an attractive option reported by Makris et al [36].…”

“…Accordingly, we currently use aggressive preoperative dilation in an attempt to establish at least 4 weeks of symptom resolution before embarking on re-ARS for such patients. If relief cannot be achieved with dilation, alternate procedures such as distal esophagectomy or Rou-en-Y esophagojejunostomy are performed [36].…”