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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Article info
Publication history
Published online: August 26, 2020
Accepted:
August 9,
2020
Received:
May 29,
2020
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
