Reflux control following gastric surgery.

Reflux is a common complication in patients who have undergone gastric surgery. These patients have bile reflux, often associated with gastric disease, and are resistant to conservative management. In this study the authors have reviewed 124 patients who were treated surgically for reflux that occurred after gastric operations. They were assessed preoperatively by history, radiologic investigation, manometry with pH and endoscopy. Seventeen patients were treated by Belsey hernia repair, 42 by partial fundoplication gastroplasty and 65 by total fundoplication gastroplasty. Thirty-seven patients required additional gastric surgery. Continued reflux was the commonest problem postoperatively; it was effectively corrected by total fundoplication gastroplasty. Of eight patients who had persistent bile gastritis, four had had bile drainage as part of their operation for reflux. From this study the authors conclude that total fundoplication gastroplasty is the most effective procedure to control reflux, but it must be carefully tailored to avoid overcompetence and dysphagia. Associated gastric problems should be treated simultaneously.