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Updated: Jun 20, 2026
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Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Roux-en-Y reconstruction for failed fundoplication.
Konstantinos I Makris1, Tommy Lee, Sumeet K Mittal
1Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131, USA.
Summary
Roux-en-Y (RNY) reconstruction is a safe option for patients with failed fundoplications, offering symptom relief. While effective, this surgical approach is associated with increased morbidity.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reflux Management
Background:
- Redo fundoplication is a common procedure for failed anti-reflux surgeries.
- A subset of patients require more complex reconstructions for persistent symptoms.
Purpose of the Study:
- To evaluate the safety and efficacy of Roux-en-Y (RNY) reconstruction in patients with previously failed fundoplications.
- To assess RNY gastrojejunostomy (GJ) or esophagojejunostomy (EJ) as a salvage procedure.
Main Methods:
- Retrospective review of 22 patients undergoing short-limb RNY GJ or EJ between 2005-2007.
- Analysis of patient history, including previous anti-reflux procedures and gastrectomy status.
- Assessment of postoperative complications, symptom scores (heartburn, regurgitation, dysphagia), and BMI changes.
Main Results:
- 18 patients had RNY GJ, 4 had EJ; 13 also underwent gastrectomy.
- 32% of patients experienced complications within 30 days, with no mortality.
- Significant symptom improvement observed at mean 23-month follow-up (heartburn 0.38, regurgitation 0.23, dysphagia 0.7).
- Mean BMI decreased from 31 preoperatively to 25.4 postoperatively.
Conclusions:
- Roux-en-Y reconstruction is a safe and valid surgical option for complex cases of failed anti-reflux procedures.
- This approach is suitable when redo fundoplication is not feasible or likely to succeed.
- Higher morbidity is associated with RNY reconstruction compared to primary anti-reflux surgery.
