Bile Diverting Operations in the Management of Reflux Esophagitis

  • Jameson L. Chassin


After several 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-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-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 followup has not been reported. Similar results were reported by Royston, Dowling, and Spencer in a series of eight patients, six of whom had undergone multiple previous operations at the esophagogastric junction. These authors stated that “none of the patients had any heartburn from the day of operation onwards.” These good results persisted during a followup period of 11–20 months.


Gastroesophageal Reflux Reflux Esophagitis Gastric Pouch Esophagogastric Junction Interrupted Suture 
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  1. Payne WS (1970) Surgical treatment of reflux esophagitis and stricture associated with permanent incompetence of the cardia. Mayo Clin Proc 45: 553PubMedGoogle Scholar
  2. Royston CMS, Dowling BL, Spencer J (1975) Antrectomy with Roux-en-Y anastomosis in the treatment of peptic oesophagitis with stricture. Br J Surg 62: 605CrossRefGoogle Scholar
  3. Smith J, Payne WS (1975) Surgical technique for management of reflux esophagitis after esophagogastrectomy for malignancy. Further application of Roux-en-Y principle. Mayo Clin Proc 50: 588Google Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.New York University School of MedicineUSA
  2. 2.Booth Memorial Medical CenterFlushingUSA
  3. 3.University Hospital, New York University Medical CenterUSA
  4. 4.New York Veterans Administration HospitalUSA
  5. 5.Bellevue HospitalUSA

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