The results of the surgical treatment of alkaline reflux gastritis

Abstract

Background/aims: Alkaline reflux gastritis (ARG) is a major complication of gastric surgery. The symptoms of ARG may be intractable and remedial surgery may be required in this patients. The goal of this study was to present our experience reviewing surgical treatment of reflux gastritis.

Methodology: During a 19-year period, we surgically treated 35 patients who had refractory ARG. Previously, gastric surgery was distal gastrectomy-gastrojejunostomy in 20 patients; truncal vagotomy-gastrojejunostomy in 11 and truncal vagotomy-pyloroplasty in 4 patients. Of 20 patients who underwent distal gastrectomy, 13 were treated with Roux-en-Y gastrojejunostomy, 6 with jejunal segment between the gastric pouch and duodenum (Henley technique) and one with conversion of Billroth II to Billroth I. Of 11 patients who initially underwent vagotomy-gastrojejunostomy, 8 were treated with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy and 3 with dismantling of a gastrojejunostomy, conversion of pyloroplasty. Four patients who originally underwent vagotomy pyloroplasty were managed with Billroth II type gastrectomy and Roux-en-Y gastrojejunostomy.

Results: Mortality rate of this series was zero. Long-term follow-up was obtained in 29 (83.0%) patients. According to Visick criteria, twelve patients (41.4%) reported exellent; ten (34.5%) good; three (10.3%) fair and four (13.8%) unsatisfactory results respectively.

Conclusions: Remedial gastric surgery can be indicated in patients who had persistent ARG symptoms despite conservative management. Careful patient selection is essential to achieve best results.