641. COMPARISON OF SURGICAL TREATMENTS FOR GASTROESOPHAGEAL REFLUX IN SYSTEMIC SCLEROSIS

Abstract Background This study proposes to compare the results of refractory gastroesophageal reflux disease (GERD) in patients with Systemic sclerosis, aiming to compare the results of different surgical approaches. Methods 44 patients are presented, followed between 2005 and 2024, diagnosed with Systemic Sclerosis and referred to our service. Just 7 patients were submitted to surgical treatment of GERD. Three different were done: partial fundoplication, Roux-en-Y gastroplasty, and Esophagectomy. Results Considering the 44 patients, just 15,9 % were operated. Two underwent partial fundoplication, 2 esophagectomies, and 3 gastric bypasses. The patients submitted to esophagectomy had delayed or incomplete esophagic emptying, and the patients who underwent gastric bypass, even with total aperistalsis showed good esophagic emptying during a barium swallow. Only patients without aperistalsis were offered partial fundoplication. We had no mortality, and the morbidity was 33% in gastric Bypass, with no morbidity in the fundoplication and esophagectomy group. The patients submitted to bypass presented better QOL and reflux control. Conclusion The surgical approach to the treatment of GERD in Systemic sclerosis is recommended just in selective cases and should be tailored concerning the clinical conditions and the esophagus emptying of each patient.