Journal of Gastrointestinal Surgery

, Volume 14, Issue 3, pp 470–475 | Cite as

An Antireflux Anastomosis Following Esophagectomy: A Randomized Controlled Trial

  • Ahmad Aly
  • Glyn G. Jamieson
  • David I. Watson
  • Peter G. Devitt
  • Roger Ackroyd
  • Chris J. Stoddard
Original Article

Abstract

Background

Reflux of duodeno-gastric fluid is a significant problem after esophagectomy with gastric conduit reconstruction. Symptoms may be severe and impact considerably upon the quality of life. Previous studies have suggested that a fundoplication type anastomosis may limit post-esophagectomy reflux.

Aim

The purpose of this study was to determine whether a modified fundoplication at the gastro-esophageal anastomosis prevents reflux after esophagectomy.

Methods

Prospective multicenter randomized controlled trial to compare a conventional end of esophagus to side of gastric conduit anastomosis with a modified fundoplication anastomosis in patients undergoing esophagectomy with intrathoracic anastomosis. Major outcomes were reflux symptoms, symptoms of dysphagia, and complications.

Results

Fifty-six patients were enrolled. The fundoplication anastomosis was associated with significantly lower incidence of reflux (40% vs 70%), as well as a reduced incidence of severe reflux (8% vs 30%). Disturbance of sleep due to reflux was significantly reduced in the fundoplication group (18% vs 47%) as was the incidence of respiratory symptoms. The fundoplication anastomosis was not associated with an increase in dysphagia, and there was no difference in complications between the two groups.

Conclusions

Fundoplication anastomosis during esophagectomy is effective in protecting patients from reflux symptoms after esophagectomy and improves quality of life, particularly with regard to sleep disturbance.

Keywords

Esophagectomy Reflux Esophageal cancer Fundoplication Anastomosis 

References

  1. 1.
    Schuetz J. Long term outcomes following esophagectomy. Chest Surg Clin North Am 2000;10:639–648.Google Scholar
  2. 2.
    Dresner SM, Wayman J, Bennet MK, Hayes N, Griffin SM. A human model of duodeno-gastro-esophageal reflux in the development of Barrett’s Metaplasia. BJS 2003;90:1120–1128.CrossRefGoogle Scholar
  3. 3.
    Wang Q, Zhao X. Can esophagogastric anastomosis prevent gastresophageal reflux? Chin J Surg. 1999;37:71. (abstract).PubMedGoogle Scholar
  4. 4.
    Gutschow C, Collard JM, Romagnoli R et al. Denervated stomach as an esophageal substitute recovers intraluminal acidity with time. Ann Surg 2001;233:509–514.CrossRefPubMedGoogle Scholar
  5. 5.
    Aly A, Jamieson GG. Reflux After Esophagectomy. Br J Surg 2004;91:137–141.CrossRefPubMedGoogle Scholar
  6. 6.
    Aly A, Jamieson GG, Pyragius MM, Devitt PG. An antireflux anastomosis following esophagectomy. ANZ J Surg 2004;74:434–438.CrossRefPubMedGoogle Scholar
  7. 7.
    Dakkak M, Bennet JR. A new dysphagia score with objective validation. J Clin Gastroenterol 1992;14:99–100.CrossRefPubMedGoogle Scholar
  8. 8.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M et al. The European Organisation for Research and Treatment of Cancer QLQ-30: A quality of life instrument for use in international trials in oncology. J Natl Cancer Inst 1993;85:365–367.CrossRefPubMedGoogle Scholar
  9. 9.
    Liedman B, Ruth M, Sandbeg N, Olbe L, Lundell L. Prevention of reflux after esophageal resection and reconstruction with a gastric tube. Dis Esoph 1994;7:188–192.Google Scholar
  10. 10.
    Butterfield W. Anti-reflux palliative resections for inoperable carcinoma of esophagogastric junction. J Thorac Cardiovasc Surg 1971;62:460–464.PubMedGoogle Scholar
  11. 11.
    Boyd A, Cukingnan R, Engelman R et al. Esophagogastrostomy: analysis of 55 cases. J Throac Cardiovasc Surg 1975;70:817–825.Google Scholar
  12. 12.
    Velanovich V, Mohlberg N. The split-stomach fundoplication after esophagogastrectomy. J Gastrointest Surg 2006;10:178–83. discussion 184–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Russell M, Thourani V, Miller J. Modified nissen fundoplication combined with Ivor Lewis esophagogastrectomy. Ann Thorac Surg 2007;84:1780–1782.CrossRefPubMedGoogle Scholar
  14. 14.
    Borst H, Dragojevic D, Stegmann T et al. Anastomotic leakage, stenosis and reflux after esophageal replacement. World J Surg 1978;2:861–864.CrossRefPubMedGoogle Scholar
  15. 15.
    Bemelman W, Verburg J, Brummelkamp W, Klopper P. A physical model of the intrathoracic stomach. Am J Physiol 1988;254:G168–G175.PubMedGoogle Scholar
  16. 16.
    Dragojevic D, Hertzer R, Corterier H. Reflux esophagitis after cardia resection in an experimental model pattern. Second World Congress of Collegium Internationale Chirurglae Strasbourg 1972.Google Scholar
  17. 17.
    McKeown KC. In Jamieson GG, ed. Surgery of the Oesophagus, Chapter 75. Melbourne: Churchill Livingstone, 1988, pp 684–685.Google Scholar
  18. 18.
    Johansson J, Johnson F, Groshen S, Walther B. Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses. J Thorac Cardiovasc Surg 2000;119:1298–1300.Google Scholar
  19. 19.
    Lerut T, Coosemans P, De Leyn P et al. Gastroplasty: yes or no to gastric drainage procedure. Dis Esoph 2001;14:173–177.CrossRefGoogle Scholar
  20. 20.
    Kobayashi A, Ide H, Eguchi R et al. The efficacy of pyloroplasty affecting to (sic) oral intake and quality of life using reconstrucion with gastric tube pull up esophagectomy. Nippon Hyobu Geka Gakkai Zasshi 1996;44:770–778. *Abstract.Google Scholar
  21. 21.
    Demos N, Kulkarni V, Port A, Micale J. Control of post resection gastresophageal reflux: the intercostal pedicle esophagogastropexy experience of 20 years. Am Surg 1993;59:137–148.PubMedGoogle Scholar
  22. 22.
    Watkins D, Prevedel A, Harper F. A method of preventing peptic esophagitis following esophagogastrostmy. J Thorac Surg 1954;28:367–381.PubMedGoogle Scholar
  23. 23.
    Wooler G. Reconstruction of the cardia and fundus of the stomach. Thorax 1956;11:275–280.CrossRefPubMedGoogle Scholar
  24. 24.
    Proctor D. The ink well anastomosis in esophageal reconstruction. SA Med J 1967;41:187–191.Google Scholar
  25. 25.
    Warra P, Oster J, Funch-Jensen P et al. A long term follow up of patients resected for benign esophageal stricture using the inkwell esophagogastrostomy. Ann Surg 1979;190:214–217.CrossRefGoogle Scholar
  26. 26.
    Yalav E, Ercan S. Reservior and globe-type antireflux surgical techniques in intrathoracic esophagogastrostomies. Dis Esoph 2000;13:282–287.CrossRefGoogle Scholar
  27. 27.
    Lortat-Jacob J, Maillard J, Fekete F. A procedure to prevent reflux after esophagogastric resection: experience with 17 patients. Surgery 1960;50:600–611.Google Scholar
  28. 28.
    DeMeester S. Colon interposition following esophagectomy. Dis Esoph 2001;14:169–172.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Ahmad Aly
    • 1
  • Glyn G. Jamieson
    • 2
  • David I. Watson
    • 3
  • Peter G. Devitt
    • 2
  • Roger Ackroyd
    • 4
  • Chris J. Stoddard
    • 4
  1. 1.Austin HospitalMelbourneAustralia
  2. 2.Department of Surgery, Royal Adelaide HospitalUniversity Of AdelaideAdelaideAustralia
  3. 3.Department of Surgery, Flinders Medical CentreFlinders UniversityAdelaideAustralia
  4. 4.Royal Hallamshire HospitalSheffieldUK

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