Department of Surgery, North Shore Hospital, Auckland, New Zealand.
School of Medicine, University of Notre Dame, Australia CNI Meadow bank, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Apr;92(4):764-768. doi: 10.1111/ans.17460. Epub 2022 Jan 6.
The management of patients with gastroparesis and recurrent reflux after previous fundoplication is challenging. The aim of this study was to evaluate the safety and efficacy of subtotal gastrectomy with Roux-en-Y reconstruction as a remedial procedure in this select patient population.
Retrospective analysis of a prospectively populated database identified all patients that underwent subtotal gastrectomy with Roux-en-Y reconstruction (SGRNY) due to reflux symptoms and delayed gastric emptying (DGE). Demographic, intra-operative and post-operative data including pre and post-operative modified reflux aspiration scintigraphy studies were evaluated. Standardized questionnaires were used to assess symptomatic outcomes.
From 2018 SGRNY has been selectively performed in 13 patients. Preoperative workup confirmed DGE and severe symptomatic reflux in all patients. The median number of previous fundoplication and or hiatal hernia operations was two (range 1-3). The mean hospital length of stay was 10 ± 6 days. Post-operative morbidity was experienced in three patients (23%). Seven patients (64%) had significant improvement or complete resolution of reflux on post-operative scintigraphy. Symptom improvement was reported in 92% of patients.
In a select patient cohort with post-fundoplication reflux and DGE symptoms, SGRNY is a moderately safe and effective salvage option.
胃轻瘫和先前胃底折叠术后反复反流的患者管理具有挑战性。本研究旨在评估胃大部切除加 Roux-en-Y 重建术作为该选择患者人群的补救程序的安全性和有效性。
回顾性分析前瞻性填充数据库，确定所有因反流症状和胃排空延迟（DGE）而行胃大部切除加 Roux-en-Y 重建术（SGRNY）的患者。评估人口统计学、术中及术后数据，包括术前和术后改良反流抽吸闪烁显像研究。使用标准化问卷评估症状结果。
自 2018 年以来，SGRNY 已选择性地在 13 名患者中进行。术前检查确认所有患者均存在 DGE 和严重的症状性反流。先前胃底折叠术和/或食管裂孔疝手术的中位数为 2 次（范围 1-3 次）。平均住院时间为 10±6 天。术后有 3 名患者（23%）发生并发症。7 名患者（64%）术后闪烁显像显示反流有明显改善或完全缓解。92%的患者报告症状改善。
在胃底折叠术后有反流和 DGE 症状的选择患者队列中，SGRNY 是一种中等安全且有效的挽救选择。
