REDO FUNDOPLICATION AND ROUX-EN-Y DIVERSION FOR FAILED FUNDOPLICATION: A 3-YEARS SINGLE-CENTER EXPERIENCE
Luca Giulini*1,2, Deepika Razia1,2, Sumeet Mittal1,2,3
1St. Joseph’s Hospital and Medical Center, Phoenix, AZ; 2Norton Thoracic Institute, St Joseph’s Hospital and Medical Center, Dignity Health, Phoenix, AZ; 3Creighton University St. Joseph's Hospital and Medical Center, Phoenix, AZ
Introduction:
Redo fundoplication (RF) and Roux-en-Y diversion (RNY) are both accepted surgical options for the treatment of recurrent GERD after failed fundoplication. However, although the effectiveness of RNY has already been demonstrated, this procedure is more commonly considered as an option only after several failures, probably because of the greater invasiveness and the higher reported morbidity. In fact, the role of RNY in the treatment of recurrent GERD is still unclear. The aim of the study was to investigate the perioperative outcomes of our 3-years single-surgeon experience.
Methods:
A prospectively maintained database was retrospectively reviewed for data on patients who underwent RF and RNY in our institution between the years 2016 and 2019. All of the operations were performed from a single surgeon (SKM). Patients with previous bariatric surgery were excluded from the study.
Results:
According to the inclusion criteria 43 patients were identified. Twenty-eight (19 female, 9 male) underwent RF and 15 (11 female, 4 male) RNY. The mean BMI was 28.6 (± 5.1) kg/m2 in the RF and 32.7 (± 4.7) kg/m2 in the RNY-group respectively (p<0.05). In the RF group 23 subjects (82%) had one and 5 (18%) had 2 previous anti-reflux procedures, while in the RNY-group 12 (80%) had one, 1 (7%) had two and 2 (13%) had three previous operations. Most of the surgeries [25 (89%) RF and 14 (93%) RNY] were performed laparoscopically. Three (11%) RF had to be converted via laparotomy and one (7%) RNY was primarily planned open. RNY took longer than RF (median 165 min vs 137 min, p<0.05), but there was no difference in the estimated blood loss between the groups (median 50 ml vs 50 ml, p=0.82). Regarding to intraoperative complications such as bleedings and hollow organs perforations there was no difference between the groups either [7 (25%) RF vs 1 (7%) RNY, p=0.22]. Postoperative complications were more common in the RF group [6 (21%) vs 1 (7%)], but the difference was not statistically significant (p=0.39). The median hospital stay was 3 days for both RF and RNY (p=0.78).
Conclusions:
RNY diversion, if performed from an experienced surgeon, is a feasible and safe procedure for the definitive treatment of recurrent GERD, with comparable perioperative morbidity to RF. Further studies should be provided to better define the role of RNY in this clinical field.
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