Management of debilitating bile reflux after esophagectomy with Roux-en-Y diversion

Area of Science:

• Gastrointestinal Surgery
• Esophageal Reconstruction
• Surgical Outcomes

Background:

• Esophagectomy with pyloroplasty can lead to severe complications like bile reflux, aspiration pneumonia, and conduit dysfunction.
• Limited literature exists on patient selection and surgical management strategies for these post-esophagectomy complications.

Purpose of the Study:

• To investigate the patient selection criteria and surgical outcomes for Roux-en-Y diversion (REYD).
• To evaluate the effectiveness of REYD in managing debilitating bile reflux following esophagectomy.

Main Methods:

• Retrospective review of 91 patients undergoing Roux-en-Y reconstruction from 2009-2020.
• Focused analysis on 17 patients who received REYD for post-esophagectomy bile reflux, with 16 having prior pyloroplasty.
• Data collection included demographics, preoperative symptoms (nausea, vomiting, reflux, aspiration pneumonia), operative details, and postoperative outcomes using quality registries and medical records.

Main Results:

• REYD was performed a median of 3.06 years after esophagectomy.
• Significant symptom reduction observed: 77% decrease in nausea/vomiting, 73% in reflux/regurgitation, and 60% in aspiration pneumonia.
• Low rates of serious complications; common complaints included nausea, vomiting, and regurgitation. Long-term interventions were rare (hernia repair, dilation, jejunostomy tube).

Conclusions:

• Roux-en-Y diversion (REYD) is an effective treatment for debilitating bile reflux in select patients after esophagectomy.
• REYD offers significant symptom relief when conservative medical management has been optimized.
• Careful patient selection is crucial for successful outcomes with REYD.