Failure of long limb Roux-en-Y reconstruction to prevent alkaline reflux esophagitis after total gastrectomy.

Postoperative reflux esophagitis is usually not seen in connection with Roux-en-Y reconstruction after total or subtotal gastrectomy. An isoperistaltic jejunal limb of adequate length (over 40 cm) is considered to prevent reflux of duodenal contents into the esophagus with consequent injury of the esophageal mucosa that otherwise may ensue. The present paper describes four patients who developed postoperative reflux esophagitis as a complication after total gastrectomy, despite a well-functioning Roux-en-Y reconstruction. It is possible that the intraabdominal generalization of cancer which was concomitantly observed in three of our four patients, may have had a contributory influence on the development of the condition by decreasing esophageal mucosal resistance, thus rendering the mucosa vulnerable to even minimal amounts of intra-esophageal regurgitation of duodenal contents, and that alkaline reflux esophagitis appearing after an interval in a patient who had an adequate Roux-en-Y reconstruction after total gastrectomy, may be the first sign of intraabdominal tumor recurrence despite negative x-ray examinations.