INTRODUCTION: Gastric dysfunction is a challenging disease, often requiring additional surgical interventions to help alleviate poor gastric motility or unremitting symptoms.MATERIALS AND METHODS: A single surgeon’s complete operative experience from 9/02 to 7/08 was reviewed. Patients with a diagnosis of gastric dysfunction that underwent revisional surgery were selected for review. Patients were examined for age, sex, initial procedure and indication, presenting symptoms, surgery performed, complications, and resolution of symptoms.RESULTS: Seventeen patients underwent a total or near-total gastrectomy with Roux-en-Y (RY) reconstruction. Two were male and fifteen were female, the average age was 55 (range 29-78). Thirteen patients presented after surgical therapy for peptic ulcer disease (Billroth I, Billroth II, Gastrectomy with Vagotomy, Vagotomy & Pyloroplasty), 2 patients had gastric dysfunction from iatrogenic vagal nerve injury from Nissen fundoplication, one patient had severe diabetic gastroparesis, and one patient had a Billroth II for carcinoid. The most common presenting symptoms were nausea (16 pts), vomiting (16 pts), weight loss (11 pts), abdominal pain (10 pts), and reflux (9 pts). All patients underwent near complete gastrectomies with RY reconstruction, 12 were done laparoscopic, three were done open, and two were converted to open. Thirteen patients reported improvement in symptoms (average follow-up 12 months). Two patients reported minimal or no improvement in symptoms and two patients had only one month follow-up. Post operative complications included wound infection (3 pts), bowel obstruction requiring surgery (1 pt), and jejunostomy tube leak requiring revision (1 pt). There were no mortalities.CONCLUSIONS: Revisional gastric surgery may be required after surgical treatment for peptic ulcer disease and may be indicated for iatrogenic vagal nerve injury or diabetic induced medically refractory gastroparesis. The most common presenting symptoms are nausea and/or vomiting with reflux and weight loss. Near total gastric resection with roux-en-y reconstruction resulted in 87% of patients with improved symptoms.