The operations of Nissen, Hill, and Belsey are adequate in controlling esophaegeal reflux in the majority of @entity1 . In a small percentage however, objective and subjective evidence of @entity2910 persists in spite of repeated operations to restore lower esophageal sphincter competency. These failures are then usually treated by operative procedures of great magnitude involving organ interposition. Repeated antireflux operations directed to the gastroesophageal area may in some instances result in impairment of blood supply with an increased risk of both esophageal and gastric fistulae. In the past many observers have felt that @entity354 resulted solely from the effects of acid-pepsin secretions bathing the distal esophagus. Recently experimental and clinical data have indicated the importance of duodenal contents in the etiology and perpetuation of @entity354 . During a recent two year period, 6 @entity1 with persistent @entity354 uncontrolled by repeated antireflux procedures have been seen on our service. These 6 @entity1 , underwent 12 unsuccessful antireflux operations elsewhere. Three of the 6 @entity1 had also been subjected to vagotomy-antrectomy for a coexisting duodenal @entity1066 . A marked lowering of @entity356 took place but esophageal reflux and @entity2910 persisted. These three @entity1 were treated on our service by takedown of the Billroth I @entity254 , closure of the duodenal stump and diversion of the duodenal contents into a Roux-en-Y limb. Three other @entity1 who had undergone unsuccessful antireflux procedures alone were subjected to antral resection, Roux-en-Y diversion and transthoracid vagotomy. This simplified appraoch to the treatment of persistent esophageal reflux uncontrolled by repeated antireflux procedures has given satisfactory results. The operation should be considered when technical considerations preclude further surgical attempts to perform another effective antireflux operation. Total duodenal diversion should, however, not be considered as the primary operation for the @entity1 suffering from @entity354 . However, in circumstances discussed above this direct approach appears preferable to major resectional procedures.

Total duodenal diversion for treatment of XXXX uncontrolled by repeated antireflux procedures.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity2910 :: ('MESH:D004941', 'Disease') :: ['esophagitis'] @entity1066 :: ('MESH:D014456', 'Disease') :: ['ulcer'] @entity254 :: ('MESH:C563598', 'Disease') :: ['anastomosis'] @entity354 :: ('MESH:D005764', 'Disease') :: ['reflux esophagitis'] @entity356 :: ('MESH:D013274', 'Disease') :: ['gastric acidity']
@entity354 :: (MESH:D005764,Disease) :: ['reflux esophagitis']
