[Severe peptic esophagitis. Treatment by total duodenal diversion]

Total duodenal bypass, as described by Holt and Large and by Herrington consists of antrectomy with Y-loop gastro-jejunal anastomosis and total vagotomy. It is performed in patients with severe oesophagitis for which oesophageal resection often proves inadequate. It applies not only to acid reflux oesophagitis but to oesophagitis caused by alkaline or mixed reflux, the severity of which has been emphasized in numerous publications. This technique was used in 12 patients operated upon for severe oesophagitis consecutive to oesophageal resection or to Heller's operation for megaoesophagus or after failure of conservative treatment of peptic oesophagitis. Seven patients benefited from the operation performed by first-intention. Total duodenal bypass was considered indicated in severe peptic stenosis (impassable with an 11 mm fiberoscope) or in severe oesophagitis with moderate stenosis (passable with an 11 mm fiberoscope) or in severe non-stenotic oesophagitis on brady--or endobradyoesophagus. The favourable results obtained, based on clinical, radiological, endoscopic and pH-metric data, confirm that the technique is effective. The risk of anastomotic ulcer is avoided by truncular vagotomy, a procedure which must not be performed by the abdominal route in patients who previously underwent Heller's operation.