Roux-en-Y Reconstruction After Esophagectomy for Postoperative Functional Complaints: A Case Series.

BACKGROUND: Esophagectomy with gastric conduit reconstruction is associated with functional complaints impacting quality of life in approximately half of patients, including delayed gastric emptying and reflux. Current management strategies have limited effect, and no standard surgical procedure exists to address these debilitating symptoms. Roux-en-Y reconstruction has emerged as a potential solution by creating duodenal diversion, promoting gastric conduit emptying, and eliminating the reflux of bile and pancreatic secretions into the gastric conduit. METHODS: We report a case series of nine patients who underwent Roux-en-Y reconstruction with a gastric conduit-jejunostomy after esophagectomy due to functional complaints between 2015 and 2024 who had at least a median follow-up of 1 year. RESULTS: Nine patients underwent Roux-en-Y reconstruction. Primary indications included obstructive symptoms (n = 8), redundant gastric conduit (n = 8), weight loss (n = 7), bile reflux (n = 5), and gastro-esophageal reflux (n = 1). All procedures were completed successfully with one Clavien-Dindo Grade IIIb complication (fascial dehiscence). No Grade 4 or 5 complications were observed. At 3-month follow-up, complete symptom resolution was achieved in six out of nine patients (67%). Complete symptom resolution at 1 year follow-up was achieved in eight out of nine patients (89%). CONCLUSION: Substantial symptom improvement and acceptable and transient postoperative morbidity indicate that Roux-en-Y reconstruction is a viable treatment option for patients with persistent functional complaints following esophagectomy with gastric conduit reconstruction.