Bile Diverting Operations in the Management of Reflux Esophagitis and Alkaline Reflux Gastritis

Abstract

After one or more failed procedures for gastroesophageal reflux, one may elect to attack the esophagogastric junction another time by performing either a Collis-Nissen operation or a jejunal interposition procedure. If the patient is a poor-risk candidate for a formidable repeat dissection in the region of the esophagogastric junction, or if the technical difficulties are overwhelming, a possible alternative is a distal gastrectomy combined with a Roux-en-Y gastrojejunostomy. In 1970 Payne reported 15 patients who were suffering from “permanent incompetence of the cardia” and who were treated by vagotomy, hemigastrectomy, and Roux-en-Y gastrojejunostomy. All had severe esophagitis and six of the patients had serious strictures. Three patients suffered from achalasia and two from scleroderma of the esophagus. All of the patients had satisfactory results, although long-term follow-up has not been reported.