Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131, USA.
J Gastrointest Surg. 2009 Dec;13(12):2226-32. doi: 10.1007/s11605-009-0994-4. Epub 2009 Sep 2.
Redo fundoplication has acceptable outcomes in patients with failed previous fundoplications. However, a subset of patients require Roux-en-Y (RNY) reconstruction for symptom relief.
The aim of this study was to demonstrate safety and efficacy of RNY reconstruction for failed fundoplications.
Retrospective review of data on patients who underwent short-limb RNY gastrojejunostomy (GJ) or esophagojejunostomy (EJ) between the years 2005 and 2007 was performed.
Twenty-two patients underwent RNY reconstructions. Fourteen (64%) patients had one, six (27%) patients had two, and 2 (9%) patients had three previous anti-reflux procedures. RNY GJ was performed in 18 patients and EJ in four patients. Gastrectomy was performed in 13 of these patients. Seven patients (32%) had ten major or minor complications within the 30-day postoperative period, without any mortality observed. At a mean follow-up of 23 months, completed in 21 of these patients (95%), the average heartburn score was 0.38 (range, 0-2). The average regurgitation score was 0.23 (range, 0 to2) and the average dysphagia score was 0.7 (range, 0-2). The mean postoperative BMI was 25.4 compared to a preoperative BMI of 31.
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.
对于先前抗反流手术失败的患者，再次行胃底折叠术（fundoplication）具有可接受的效果。然而，有一部分患者需要行 Roux-en-Y（RNY）重建术以缓解症状。
本研究旨在证明 RNY 重建术治疗失败的抗反流手术的安全性和有效性。
回顾性分析了 2005 年至 2007 年间行短襻 RNY 胃空肠吻合术（GJ）或食管空肠吻合术（EJ）的患者数据。
22 例患者接受了 RNY 重建术。14 例（64%）患者进行了一次手术，6 例（27%）患者进行了两次手术，2 例（9%）患者进行了三次先前的抗反流手术。18 例患者行 RNY GJ，4 例患者行 EJ。其中 13 例患者行胃切除术。7 例（32%）患者在术后 30 天内发生 10 例重大或轻微并发症，但无死亡病例。在这些患者中的 21 例（95%）平均随访 23 个月后，平均烧心评分为 0.38（范围，0-2）。平均反流评分为 0.23（范围，0-2），平均吞咽困难评分为 0.7（范围，0-2）。术后平均 BMI 为 25.4，术前 BMI 为 31。
对于先前抗反流手术失败的患者，再次行 RNY 重建术，包括 GJ 或 EJ，是一种安全、有效的手术选择，适用于再次行胃底折叠术不可行或预计会失败的困难情况。然而，它与较高的发病率相关。
