Vagotomy Antrectomy and RouxenY Diversion

Multiple failed anti-reflux operations, a short and strictured esophagus, or a failed Collis gas-troplasty with either a partial or a total fundo-plication may require a more radical approach. Resection of the damaged lower esophagus and reconstruction with the stomach to be left in the distal mediastinum is not an acceptable solution, because restricture by reflux can be expected in nearly 100% of patients so treated. Payne61 treated this permanent incompetence of the cardia by adding a bilateral truncal vago-tomy with an antrectomy for acid suppression and a Roux-en-Y diversion of all pancreato-biliary secretions using a long jejunal limb. Ellis and Gibb62 and Fekete and Pateron63 reported their respective experience using this operation. These authors reported a >80% success with this treatment.

Csendes and associates16 observed an extremely high failure rate when treating Barrett's esophagus patients using conventional anti-reflux repairs. With this observation, they opted for bilateral vagotomy, antrectomy and long-limb Roux-en-Y diversion as primary treatment for these patients. They tried biliary diversion without resection (duodenal switch) but observed a better acid reflux control if an antrectomy was selected. Using this operation, they observed a reduction of low-grade dyspla-sia in the esophageal columnar-lined mucosa in 50% of treated patients.

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Responses

  • lucie
    What is Rouxenydiversion?
    7 years ago

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