Bile Diversion Operations

Operations are designed to divert the duodenal content away from the stomach and,hence, from the esophagus. The total duodenal diversion (TDD) as based on the principles of Cesar Roux is the first and still the most popular operation used when the reflux occurs after gastric resection. Other operations that were subsequently developed include the Tanner 19 Roux-en-Y operation, the Braun enteroenterostomy, and the Henley anisoperistaltic jejunal interposition. In 1985, after an experimental study, DeMeester et al.50 proposed a new physiologic approach to the problem of DGER with the duodenal switch procedure. More recently, Madura and Grosfeld51 advocated the use of simple biliary diversion. Overall, these procedures are used only in a fraction of the patients showing severe DGER.

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