Remedial bypass or antrectomy and Roux-en-Y after failed fundoplication

Excellent outcomes have been reported with primary antireflux surgery; however, some patients require reoperation. Of the patients who undergo reoperation, a select few are at higher risk for poor outcomes after redo fundoplication. The high-risk group includes patients who are morbidly obese; those with a short esophagus, poor esophageal motility, or patients who have undergone; multiple (i.e., more than 2) reoperative procedures; and those with delayed gastric emptying. These patients are better served with Roux-en-Y (RNY) gastrojejunostomy, with or without gastrectomy. In this article, we summarize our approach for reoperative intervention after antireflux surgery has failed, and discuss criteria for patient selection, operative technique, and outcomes of RNY reconstruction as a remedial antireflux procedure.