title: [Value of distal gastrectomy as a remedial operation for failed fundoplication].
abstract: BACKGROUND
  Failure of conventional antireflux surgery is a challenging problem. This study aims at defining the role of distal gastrectomy with Roux-en-Y diversion in the treatment of failed fundoplication.
  
  
  METHODS
  This report reviews the indications and results of 26 patients who underwent revisional antireflux surgery in our department. Distal gastrectomy and Roux-en-Y reconstruction were performed in 6 patients (group a), refundoplication in 15 (group b), and re-hiatoplasty in 5 patients (group c).
  
  
  RESULTS
  Group a patients had the longest history (p = 0.001) and the highest number of previous operative procedures (p = 0.001). In contrast, hospital stay was longer and postoperative morbidity was higher after distal gastrectomy (p = n. s.). At follow-up, symptom improvement was achieved most reliably after distal gastrectomy (groups a-c: 100%, 78.6%, and 60% of patients; p = n. s.).
  
  
  CONCLUSIONS
  Distal gastrectomy with Roux-en-Y diversion is a safe and reliable surgical option for selected patients after failed fundoplication. Distal gastrectomy with Roux-en-Y diversion is a reliable surgical option for selected patients after failed fundoplication. Despite a higher morbidity, this procedure represents an important addition to the surgical armamentarium, particularly in patients with a history of multiple previous interventions.
authors.affiliation: Universität zu Köln, Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Köln, Deutschland. christian.gutschow@uk-koeln.de
authors.forename: C A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: W
authors.initials: W
authors.lastname: Schröder
authors.forename: M
authors.initials: M
authors.lastname: Bludau
authors.forename: D
authors.initials: D
authors.lastname: Vallböhmer
authors.forename: K L
authors.initials: KL
authors.lastname: Prenzel
authors.forename: E
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D003680:Deglutition Disorders / Q000175:diagnosis / Q000601:surgery; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation / Q000379:methods; D017211:Treatment Failure