A case of severe bile reflux combined with esophageal hiatal hernia after major gastrectomy cured by laparoscopic surgery Patient**, male, 76 years old, was admitted to the hospital with “34 years after major gastrectomy, reflux with burning pain and discomfort behind the sternum for 3 years”. The patient developed epigastric pain with nausea and vomiting 34 years ago, and was diagnosed with “duodenal ulcer” in a hospital, and was treated by open major gastrectomy with Bi II, which significantly relieved the discomfort. Three years ago, he developed severe gastric reflux, burning pain behind the sternum and bitterness in the mouth. Reflux is mainly seen after lying down, often woke up at night by choking on the reflux, accompanied by a large amount of gastric juice reflux into the oral cavity, nasal cavity, trachea, after reflux, there is often a violent cough, coughing up yellow mucus and part of the chyme, accompanied by fever, can be gradually relieved after patting the back, rinsing the mouth, drinking water, fever requires intravenous antibiotic treatment. In the past 3 years, he was unable to lie down and slept almost sitting down. The occurrence of reflux could be significantly reduced by diet control and sleeping with the head of the bed elevated. There was no previous history of coronary heart disease, hypertension, diabetes mellitus or other chronic diseases. Gastroscopy was performed at the hospital, which indicated a large amount of bile reflux; esophageal manometry results indicated that the UES pressure was lower than normal and the relaxation function was poor; esophageal peristalsis was poorly coordinated and the conduction in the middle part of the body was interrupted, all of which were failed peristaltic waves. After completing the above examination, the patient underwent “laparoscopic (Dor) fundoplication + esophageal hiatal hernia repair + abdominal adhesion release + jejunal Roux-en-Y anastomosis” under general anesthesia (intraoperatively, extensive abdominal cavity adhesions were seen, and they were cut open and separated one by one. The abdominal segment of esophagus and fundus herniated into the thoracic cavity was pulled into the abdominal cavity, the enlarged esophageal fissure was repaired, and the fundus was folded to prevent reflux, the jejunal input collaterals were cut at the proximal side of the original gastric-jejunal anastomosis near the anastomosis, and a jejunal Roux-en-Y anastomosis was performed between the jejunal input collaterals and the jejunal output collaterals). Discussion: The normal anatomical and physiological relationship was changed after Bi-II type major gastrectomy, and alkaline bile, pancreatic fluid and intestinal fluid flowed into the stomach through the gastrojejunal anastomosis, which destroyed the gastric mucosal barrier and led to changes in gastric mucosal congestion, edema and erosion, manifested as burning pain in the epigastrium or retrosternal area, vomiting of bile-like fluid and weight loss. Acid suppression therapy is ineffective and more persistent. Treatment may include gastric mucosal protective agents, gastric motility drugs and bile acid binding drugs. Surgical treatment is feasible for severe symptoms, usually using a modified Roux-en-Y gastrointestinal anastomosis to reduce the chance of bile reflux into the stomach, which can reduce the patient’s discomfort caused by bile reflux.