Total gastrectomy in systemic scleroderma when anti-reflux surgery is not viable: A case report

Area of Science:

• Immunology
• Gastroenterology
• Pulmonology

Background:

• Systemic scleroderma is an autoimmune disease impacting respiratory and gastrointestinal systems.
• Pulmonary hypertension and diffuse lung disease in scleroderma often necessitate lung transplantation.
• Gastroesophageal reflux disease (GERD) can contraindicate lung transplantation.

Purpose of the Study:

• To present a case where surgical correction of GERD enabled lung transplant candidacy.
• To propose open gastrectomy with Roux-en-Y anastomosis as an alternative surgical option for GERD in potential lung transplant recipients.

Main Methods:

• A 56-year-old female with systemic scleroderma, pulmonary hypertension, and GERD was evaluated for lung transplant.
• Initial GERD management was insufficient; open gastrectomy with Roux-en-Y anastomosis was performed.
• Post-operative esophagogram confirmed anatomical integrity and absence of reflux.

Main Results:

• The open gastrectomy with Roux-en-Y anastomosis successfully resolved GERD.
• The patient became a candidate for lung transplantation following successful GERD treatment.
• Post-operative imaging showed normal anatomy and adequate contrast transit.

Conclusions:

• Open gastrectomy with Roux-en-Y anastomosis is a viable surgical option for managing GERD in systemic scleroderma patients.
• This procedure can facilitate lung transplantation by resolving contraindicating GERD.
• It offers an alternative to Nissen fundoplication for select patients.