Jejunal interposition for reflux esophagitis and esophageal stricture unresponsive to valvuloplasty

Esophagitis that persists after repeated failure of operations upon the cardia and/or a fibrotic, nondilatable distal esophageal stricture is a difficult problem. In a personal, consecutive series, 28 patients had 117 prior operations upon the cardia and diaphragmatic hiatus. In these carefully selected patients, utilization of the interposed jejunal segment described by Merendino and Dillard resulted in low mortality and morbidity and, to date, uniform control of gastroesophageal malfunction. Preoperative diagnoses in the 28 patients were: nondilatable stricture in 9, unrelenting gastroesophageal reflex in 12, and a combination of both abnormalities in 7. The decision to perform jejunal interposition was made preoperatively in 15 patients and intraoperatively in 13 patients. One patient died and 11 others sustained complications, 4 of which were major. In a mean follow‐up of 5.5 years, only 2 patients required an additional operation, both for unrelated illnesses. Comparison with a similar but somewhat more favorable group of 8 patients who had another attempt at an effective antireflux procedure instead of jejunal interposition showed the results of the interposition operation to be superior. Jejunal interposition, when selectively applied and carefully conducted, is the procedure of choice for reconstruction of the malfunctioning esophagogastric junction that has been selected previously to repeated, unsuccessful operations.