808. ROUX-EN- Y GASTRIC BYPASS FOR REFRACTORY SEVERE GERD AFTER PROXIMAL GASTRECTOMY

Abstract Roux-en- Y gastric bypass for refractory severe GERD after proximal gastrectomy Category Gastro-esophageal reflux and hiatal hernia Background This is the case of a 27-year-old male diagnosed with achalasia. During dilation of the gastroesophageal junction a iatrogenic esophageal perforation occurred. Therefore, a polar gastrectomy with stapling of the lesser curvature and resection of the distal esophagus with esophagogastric anastomosis was performed. After the surgery the patient experienced symptoms of severe reflux unresponsive to PPI. Therefore, a subtotal gastrectomy with pouch construction and Roux-en-Y gastrojejunostomy was indicated. Methods We present an intraoperative video showing the surgical technique. Results The postoperative period was uneventful, with favorable response to gradual reintroduction of oral intake. The patient was discharged on the 9th POD. After a 12-month follow up the patient remains asymptomatic. Conclusions Surgery is currently the gold standard treatment for refractory reflux. In this case, the creation of a gastric pouch with Roux-en-Y bypass ensures the resolution of the symptoms of GERD as well as the gastric delay. Preservation of the gastroepiploic vessels to ensure an optimal gastric pouch perfusion is mandatory https://we.tl/t-kLUqi4AqqB