Repeated operations for severe reflux esophagitis after gastric tube resection

Abstract

Objective. To evaluate the effectiveness of repeated surgical interventions in the treatment of gastroesophageal reflux disease after gastric tube resection in patients with morbid obesity. Materials and methods. The study included 249 patients who underwent gastric tube resection from 2018 to 2024. X–ray examination, fibroesophagogastroduodenoscopy, and histological examination were used for diagnosis. The effectiveness of primary and repeated surgical interventions was analyzed: symptoms of gastroesophageal reflux disease, body mass index, and complications. Twenty–two patients were reoperated: 5 underwent gastric bypass surgery, 17 underwent plastic surgery of the esophageal opening of the diaphragm and the formation of a valve mechanism. Results. Primary surgical intervention provided effective loss of excess body weight (reduction by an average of 76.7%). In 39% of patients after gastric tube resection, symptoms of gastroesophageal reflux disease were detected. Repeated gastric bypass surgery completely eliminated the symptoms in all 5 patients, but 2 of them developed symptoms of malabsorption. Of the 17 patients who underwent plastic suturing of the esophageal opening of the diaphragm and the formation of a valve mechanism, 15 had complete resolution of symptoms and 2 had significant reduction. No complications were recorded during repeated interventions. Conclusions. Repeated surgical intervention for persistent manifestations of gastroesophageal reflux disease after gastric tube resection can be an effective alternative to medical treatment. In the presence of large hernias of the esophageal opening of the diaphragm, plastic surgery with the formation of a valve mechanism in the gastroesophageal transition zone is advisable. This approach provides a steady improvement in the condition of patients without significant risks.