Roux-en-Y reconstruction for failed fundoplication

J Gastrointest Surg. 2009 Dec;13(12):2226-32. doi: 10.1007/s11605-009-0994-4. Epub 2009 Sep 2.


Background: Redo fundoplication has acceptable outcomes in patients with failed previous fundoplications. However, a subset of patients require Roux-en-Y (RNY) reconstruction for symptom relief.

Aim: The aim of this study was to demonstrate safety and efficacy of RNY reconstruction for failed fundoplications.

Method: Retrospective review of data on patients who underwent short-limb RNY gastrojejunostomy (GJ) or esophagojejunostomy (EJ) between the years 2005 and 2007 was performed.

Results: Twenty-two patients underwent RNY reconstructions. Fourteen (64%) patients had one, six (27%) patients had two, and 2 (9%) patients had three previous anti-reflux procedures. RNY GJ was performed in 18 patients and EJ in four patients. Gastrectomy was performed in 13 of these patients. Seven patients (32%) had ten major or minor complications within the 30-day postoperative period, without any mortality observed. At a mean follow-up of 23 months, completed in 21 of these patients (95%), the average heartburn score was 0.38 (range, 0-2). The average regurgitation score was 0.23 (range, 0 to2) and the average dysphagia score was 0.7 (range, 0-2). The mean postoperative BMI was 25.4 compared to a preoperative BMI of 31.

Conclusion: RNY reconstruction with GJ or EJ for failed anti-reflux procedures is a safe, valid surgical option in difficult situations, where a redo fundoplication is either non-feasible or expected to fail. However, it is associated with higher morbidity.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Roux-en-Y* / methods
  • Esophagus / surgery*
  • Female
  • Fundoplication*
  • Gastric Bypass / methods*
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Jejunum / surgery*
  • Male
  • Middle Aged
  • Postoperative Care
  • Reoperation
  • Retrospective Studies
  • Treatment Failure
  • Treatment Outcome