Bypass with transdiaphragmatic Roux loop in nonresectable malignant stricture of the lower oesophagus

Bypass with a Roux-en-Y loop is proposed for palliation of nonresectable malignant obstruction in the distal oesophagus and cardia without peritoneal dissemination. Over a 15-year period, 51 transdiaphragmatic Roux-en-Y procedures with side-to-end oesophagojejunal anastomosis were performed. The 11.8% mortality was unrelated to anastomotic leakage. Gastrostomy should be avoided because of its nutritional and psychologic disadvantages. Other methods for surgical bypass are discussed and comparison is made with intubation. Wider indications for the Roux loop bypass are mentioned.