Roux en Y Gastrojejunostomy for the treatment of complex Esophago-Gastric problems.

Background: Roux en Y gastrojejunostomy has been proposed for the treatment: a) of complex benign esophageal problems generally in alternative to distal esophagus resection; b) of complex redo antirefl ux surgery; c) of associated gastric antrum and gastro-esophagel junction diseases, to avoid acidalkaline esophageal refl ux, common after Billroth II gastrojejunostomy. The Roux Stasis Syndrome (RSS) may impair results in 10% to 50% of cases. Aim of the study is to evaluate the incidence of RSS after Roux en Y gastrojejunostomy performed avoiding division of the jejunal mesentery, the gastrojejunal terminolateral anastomosis being vertical to optimize emptying. Methods: Of 38 patients, 27 were followed up in long term. Patients were consecutively submitted to distal gastric resection for neoplastic or functional disease of the esophageal and/or gastric tract and reconstruction with Roux en Y jejunostomy. Patients were followed up with clinical interview, barium swallow, endoscopy. Results: Mortality was 2.6% and morbility was 16.2%. Median follow-up was 113.6 months (range 6–192 months). RSS were found in 2 on 27 patients (7.4%). Two patients (with caustic injury) were then subjected to esophagocolo- gastroplasty for esophageal stenosis not otherwise treatable, one patient (already undergone two redo surgery for esophageal achalasia) complained of signifi cant dysphagia. In the remaining patients the functional result is satisfactory. Discussion: Roux en Y gastrojejunostomy is an effective option for the treatment of complex esophago-gastric problems. The Roux Stasis Syndrome may be minimized with few technical details. Disclosure: All authors have declared no confl icts of interest.