Open AccessLaparoscopic Hiatal Hernia Repair and Roux-en-Y Conversion for Refractory Duodenogastroesophageal Reflux after Billroth I Distal Gastrectomy
Author(s) -
Joong-Min Park,
Sung Jin Yoon,
Jong Won Kim,
Kyong-Choun Chi
Publication year - 2020
Publication title -
journal of gastric cancer/daehan wiam haghoeji
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.806
H-Index - 28
eISSN - 2093-5641
pISSN - 1598-1320
DOI - 10.5230/jgc.2020.20.e23
Subject(s) - medicine , billroth i , gerd , anastomosis , hiatal hernia , reflux , roux en y anastomosis , billroth ii , gastrectomy , surgery , refractory (planetary science) , general surgery , gastroenterology , disease , cancer , weight loss , gastric bypass , physics , astrobiology , obesity
Distal gastrectomy with Billroth I or II reconstruction may cause duodenogastroesophageal reflux (DGER), thereby resulting in digestive or respiratory symptoms. The mainstay of treatment is medication with proton pump inhibitors. However, these drugs may have limited effects in DGER. Laparoscopic fundoplication has been proven to be highly effective in treating gastroesophageal reflux disease (GERD), but it cannot be performed optimally for GERD that develops after gastrectomy. We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy.