[Distal Y-gastrectomy in complex and recurrent reflux]

The consequences of mixed esophagitis due to acid-peptic as well as biliary-pancreatic reflux are widely known today, even though they are partly accompanied by physiopathologic speculations. Much seems to indicate that the biliary component causes most pathologic modifications in the esophagus as the peptic reflux alone, such as Barrett, secondary brachyesophagus, strictures and even malignancy. In advanced cases with functional failure of the upper and lower sphincter, as well as the development of serious perifocal fibrosis in the thoraco-abdominal region or, often, in the cases with a multifactorial pathology after anti-reflux surgery, standard operations of the cardia is no longer possible. For many years resections or interpositions were proposed despite their morbidity, lethality and quality of life. The distal gastrectomy in healthy tissue with a long-Roux-Y drainage has proved to be a successful procedure. We present a study of 43 cases with an interesting pathology, as well as indications and long-term results.