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Long-term outcomes of Roux-en-Y gastric diversion after failed surgical fundoplication in a large cohort and a systematic review

Published:August 26, 2020DOI:https://doi.org/10.1016/j.soard.2020.08.015

      Highlights

      • -
        Data on long-term outcomes after Roux-en-Y gastric diversion (RNYG) for failed fundoplication are lacking.
      • -
        Although the majority achieved initial gastroesophageal reflux disease (GERD) symptom resolution, 39.7% of those experienced GERD recurrence during a median follow-up of 56.2 months.
      • -
        In this cohort, 46.7% had either new-onset or persistent dysphagia after RNYG.
      • -
        RNYG is an effective alternative surgery. However, patients should be informed of the risks of postoperative GERD symptoms and dysphagia.

      Abstract

      Background

      Roux-en-Y gastric diversion (RNYG) is an alternative approach for patients with persistent or recurrent gastroesophageal reflux disease (GERD) after surgical fundoplication, especially in patients with esophageal dysmotility or morbid obesity, because redo fundoplication could offer unfavorable outcomes.

      Objective

      To evaluate long-term outcomes of RNYG for failed fundoplication and its impact on esophageal function.

      Setting

      A retrospective cohort study and a systematic review.

      Methods

      Patients who underwent RNYG after failed fundoplication between 1995 and 2019 were identified. Surgical-related complications, GERD, dysphagia, and endoscopic and esophageal manometric findings were reviewed. A literature search for relevant studies was performed from several databases from database inception to September 2019.

      Results

      A total of 101 patients (mean age, 52.1 yr; 86.1% female; mean body mass index, 35.8 kg/m2) were included. Overall complication rates within and more than 30 days after surgery were 36.3% and 53.5%. GERD symptoms were resolved in 70.1% after RNYG. However, 39.7% had a recurrence during a median follow-up of 56.2 months. In patients with no baseline dysphagia (n = 36), 16 (44%) developed new-onset dysphagia after surgery. In patients with severe baseline dysphagia (n = 9), 5 patients (56%) had persistent dysphagia after surgery. Seven studies involving 381 patients were included in our systematic review. High rates of GERD improvement have been reported across studies; however, long-term GERD, dysphagia, and objective outcomes were infrequently reported.

      Conclusion

      RNYG is an effective alternative surgery in a subset of patients with intractable symptoms who failed fundoplication. However, patients should be informed of the risks of postoperative GERD symptoms and dysphagia. Referral for a careful evaluation by a multidisciplinary foregut team is warranted.

      Keywords

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