[Rationale of the surgical treatment of duodenogastroesophageal reflux].

Patients with "intact stomach" but more frequently patients operated on the esophago-gastric junction, vagus, stomach, can develope a duodeno-gastro-esophageal reflux syndrome. We propose a rationale of the surgical treatment based upon our experiences during these last 15 years in functional studies, mainly manometric, of the entire esophago-gastro-duodeno-jejunal tract. Patients with an intect stomach: a non-demolitive ("functional") technique may be proposed each time a correctable alteration of the gastro-duodenal motility is found during the manometric study. Such interventions are the association between a fundoplicatio and Extramucose Duodenal Myotomy, Duodenal Switch, Pylorectomy. On the other side when the motor alteration is too severe and uncorrectable (Prostigmine-Test) or in presence of morphological, nearly always pre-cancerous, alterations we can perform only demolitive procedures. The intervention preferred by the AA is Total Duodenal Diversion. Patients with operated stomach: the different possible surgical procedures and their results are strictly related to the intervention preceding the onset of the reflux syndrome. In fact the better results are related to bad management and to post-operative complications during the previous intervention, rather than to an ignored pre-existing motor disorder. The Total Duodenal Diversion seems to be the must reliable also in this case, both initially and in the operated patients (conversion from Billroth II to Roux). Between 1978 and 1993 we observed 604 refluxers at 24-hour pH-recording, 209 of them with alkaline or mixed gastro-esophageal reflux. On the basis of the morphologic and functional diagnostic evaluation 64 patients underwent surgery, 36 with intact stomach and 28 with operated stomach. Good results (disappearance of esophageal symptoms and improving in gastric symptoms) were obtained in 30 (83.3%) patients with intact stomach and in 25 (89.3%) with operated stomach.