Korbitz Holland, Alomari Mohammad, Edwards Michael A, Thomas Mathew, Elli Enrique F, Bowers Steven P
Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Surg Endosc. 2025 Jun 27. doi: 10.1007/s00464-025-11817-y.
Roux-en-Y gastrojejunostomy (RYGJ) is viewed as a salvage operation for fundoplication failure or obesity-related reflux, and we questioned it is long-term effectiveness in patients undergoing esophagogastric myotomy.
From an operative report database, we identified 37 patients who underwent a combination of Roux-en-Y gastrojejunostomy and esophagogastric myotomy, and retrospective chart review was performed. Dysphagia was the main presenting symptom, reported in 33 patients (89%), followed by regurgitation in 23 patients (62%) and reflux in 16 patients (43%). Sequence of operations was as follows: Myotomy then revisional Gastro-Jejunostomy (MGJ, N = 16); Concomitant Primary (CP, N = 6); Concomitant Revisional (CR, N = 8); and RYGJ then Myotomy (RM, N = 7). Of the MGJ group, five had Serra Doria esophagocardioplasty.
The median age was 57 years with 76% female. Preoperative BMI > 35 kg/m was observed in 18 patients (49%): CP, 100%; CR, 63%; MGJ, 31%; RM, 14%. There were no perioperative leaks or reoperations. The median follow-up was 18 months (range 0 to 146). Esophageal salvage was accomplished in 34 patients (92%). Late reintervention was required in 10 patients (27%). In the MGJ group, two patients required esophagectomy, and three patients underwent reoperation for other indications: one for recurrent hiatal hernia, one for internal hernia, and one for removal of a remnant gastrostomy tube. In the CR group, two patients underwent dilations and one patient received botulinum toxin injection. In RM group, one patient underwent dilation, and one required esophagectomy. Surveillance endoscopy showed no erosive esophagitis in 18/22 patients (82%), and one patient had new Barrett's esophagus. Current proton pump inhibitor (PPI) use was observed in 20 patients (54%). At last follow-up, 26 (69%) of patients were symptom-free. In patients with preop BMI > 35 kg/m, mean total body weight lost was 20.9%. No group had lower rates of reintervention, esophagitis, or PPI use.
Most patients undergoing a combination of RYGJ and myotomy experience relief of their symptoms, with esophageal salvage possible in the majority. RYGJ is an adequate anti-reflux operation after esophagogastric myotomy and offers reasonable weight control in obese patients.
Roux-en-Y胃空肠吻合术（RYGJ）被视为胃底折叠术失败或肥胖相关反流的挽救手术，我们质疑其在接受食管胃肌切开术患者中的长期有效性。
从手术报告数据库中，我们确定了37例接受Roux-en-Y胃空肠吻合术和食管胃肌切开术联合手术的患者，并进行了回顾性病历审查。吞咽困难是主要症状，33例患者（89%）报告有此症状，其次是23例患者（62%）出现反流，16例患者（43%）出现反酸。手术顺序如下：先进行肌切开术，然后进行改良胃空肠吻合术（MGJ，n = 16）；同期一期手术（CP，n = 6）；同期改良手术（CR，n = 8）；先进行RYGJ，然后进行肌切开术（RM，n = 7）。在MGJ组中，5例患者进行了Serra Doria食管贲门成形术。
中位年龄为57岁，女性占76%。18例患者（49%）术前BMI>35 kg/m²：CP组为100%；CR组为63%；MGJ组为31%；RM组为14%。围手术期无渗漏或再次手术情况。中位随访时间为18个月（范围0至146个月）。34例患者（92%）实现了食管挽救。10例患者（27%）需要后期再次干预。在MGJ组中，2例患者需要进行食管切除术，3例患者因其他指征接受了再次手术：1例因复发性食管裂孔疝，1例因内疝，1例因取出残留的胃造瘘管。在CR组中，2例患者接受了扩张治疗，1例患者接受了肉毒杆菌毒素注射。在RM组中，1例患者接受了扩张治疗，1例患者需要进行食管切除术。监测内镜检查显示，22例患者中有18例（82%）无糜烂性食管炎，1例患者出现新的巴雷特食管。20例患者（54%）目前正在使用质子泵抑制剂（PPI）。在最后一次随访时，26例（69%）患者无症状。术前BMI>35 kg/m²的患者，平均总体重减轻了20.9%。没有一组的再次干预率、食管炎发生率或PPI使用率较低。
大多数接受RYGJ和肌切开术联合手术的患者症状得到缓解，大多数患者实现了食管挽救。RYGJ是食管胃肌切开术后一种合适的抗反流手术，并且在肥胖患者中能实现合理的体重控制。
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