A Case of Severe Reflux Esophagitis after Proximal Gastrectomy Successfully Treated by Reoperation

Abstract

A 70-year-old man underwent laparoscopic gastrectomy and double-tract reconstruction for gastric cancer. About 3 months after surgery, he had heartburns. An upper gastrointestinal endoscopy revealed LA classification Grade C reflux esophagitis. His symptoms did not improve with medical therapy. His food intake decreased, resulting in a weight loss of 31 kg (72 kg preoperatively). His symptoms did not improve 5 years after surgery; therefore, he was referred for surgery. Preoperative esophageal impedance pH monitoring (MⅡ/pH) showed no decrease in pH of the liquid reflux component. Therefore, duodenal fluid was considered to be the cause of the reflux esophagitis. A total resection of the remaining stomach and anastomosis of the Y-leg (20 cm anorectal side from the anastomosis of the previous surgery) were performed. Postoperatively, his symptoms disappeared, and he observed a weight gain of 8 kg. Furthermore, an upper gastrointestinal endoscopy confirmed the cure of reflux esophagitis. In this report, we describe a case of refractory reflux esophagitis after gastrectomy with gastric resection of the volvulus, which was cured by reoperation. Reoperation is one of the treatment options for refractory reflux esophagitis after gastrectomy. The MⅡ/pH test may be useful in the diagnosis of such patients and in determining the indication for surgery.