Gallanis Amber F, Bowden Cassidy, Sharma Disha, Rodriguez Gracia Viana, Lopez Rachael, Payne Charlotte, Joyce Stacy, Broesamle Riema, Blakely Andrew M, Hernandez Jonathan M, Korman Louis, Heller Theo, Davis Jeremy L
Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: https://twitter.com/AmberFGallanis.
Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Surgery. 2025 May;181:109214. doi: 10.1016/j.surg.2025.109214. Epub 2025 Feb 16.
Bile reflux is a postgastrectomy syndrome that impacts quality of life. Management includes lifestyle modifications and medical therapy; however, the efficacy of operative intervention for refractory bile reflux is unknown. We aimed to characterize outcomes of Roux limb lengthening for management of recalcitrant bile reflux after total gastrectomy.
Retrospective analysis of 159 individuals with germline CDH1 mutations who underwent prophylactic total gastrectomy with Roux-en-Y reconstruction. Patient demographics, frequency of recalcitrant bile reflux, type of medical management, operative details, and clinical outcomes were measured.
Fourteen (8.8%, 14/159) individuals developed bile reflux recalcitrant to medical therapy after prophylactic total gastrectomy and elected for operative Roux limb lengthening of 20-25 cm. Median time from prophylactic total gastrectomy to Roux limb revision was 2.6 years (interquartile range, 2.1-2.9). After revisional surgery, all patients self-reported improvement in bile reflux symptoms. Post-Roux limb revision, almost all (86%, 12/14) patients reported rare or no bile reflux symptoms. Bile reflux severity scores improved to no symptoms in 3 patients (21%), followed by mild (50%, 7/14) or moderate (29%, 4/14) symptoms after Roux limb revision. All individuals (100%, 14/14) who underwent Roux limb revision reported "major improvement" in bile reflux symptoms with a median follow-up of 16 months (interquartile range, 7.5-21.5). Most patients regained weight post-Roux limb revision (+3.3 kg, standard deviation 4.7, P = .02) with a mean percentage weight gain of 5.9% (standard deviation, 7.4). There were no intraoperative or postoperative complications with revisional surgery.
Roux limb revision is effective for management of recalcitrant bile reflux. Additional study to identify potential risk factors for bile reflux after total gastrectomy is warranted.
胆汁反流是一种影响生活质量的胃切除术后综合征。治疗方法包括生活方式调整和药物治疗；然而，手术干预对难治性胆汁反流的疗效尚不清楚。我们旨在描述Roux袢延长术治疗全胃切除术后顽固性胆汁反流的效果。
对159例携带种系CDH1突变并接受预防性全胃切除及Roux-en-Y重建术的患者进行回顾性分析。测量患者的人口统计学数据、顽固性胆汁反流的发生率、药物治疗类型、手术细节和临床结果。
14例（8.8%，14/159）患者在预防性全胃切除术后出现药物治疗无效的胆汁反流，并选择接受20-25厘米的Roux袢延长手术。从预防性全胃切除术到Roux袢修复的中位时间为2.6年（四分位间距，2.1-2.9）。翻修手术后，所有患者均自述胆汁反流症状有所改善。Roux袢修复术后，几乎所有（86%，12/14）患者报告很少或没有胆汁反流症状。胆汁反流严重程度评分改善，3例患者（21%）无症状，Roux袢修复术后7例（50%，7/14）为轻度症状，4例（29%，4/14）为中度症状。所有接受Roux袢修复术的患者（100%，14/14）均报告胆汁反流症状“明显改善”，中位随访时间为16个月（四分位间距，7.5-21.5）。大多数患者在Roux袢修复术后体重增加（+3.3千克，标准差4.7，P = 0.02），平均体重增加百分比为5.9%（标准差，7.4）。翻修手术无术中或术后并发症。
Roux袢修复术对难治性胆汁反流有效。有必要进行进一步研究以确定全胃切除术后胆汁反流的潜在危险因素。
