Skip to main content
SpringerLink
Log in

Organ-preserving resection of the gastroesophageal junction and substitution with a gastric corpus rotation tube: an experimental study

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Premalignant lesions of the gastroesophageal junction are treated conservatively or by antireflux surgical procedures. We describe a novel technique that replaces the distal esophagus after resection of the gastroesophageal junction. After resection of the gastroesophageal junction, 16 pigs were divided into two groups. In group 1 (n = 9) the gastroesophageal junction was replaced with a 3 cm wide horizontal gastric corpus tube, pedicled at the lesser curvature. In group 2 (n = 7) the tube was pedicled at the greater curvature. Tube length, volume, and compliance of the gastric remnant and blood flow in the tube (by laser Doppler flowmetry given in perfusion units [PU]) were measured before and after tube formation and 2 weeks postoperatively. Group 1 tubes were 9.5 ±1.5 cm long and group 2 tubes were 8.2 ± 0.7 cm long. Tube formation decreased volume and compliance of the gastric remnant. After tube formation, blood flow at the tip of the tube decreased from 254 PU to 64 ±22 PU (group 1) and 87 ±36 PU (group 2). Volume, compliance, and blood flow returned to baseline values 2 weeks postoperatively. No anastomoric leakage was found on postmortem examination. Horizontal gastric corpus tubes might offer an alternative to replace the distal esophagus and proximal stomach after resection of premalignant lesions of the gastroesophageal junction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lotheisen G. Über plastischen Ersatz der Speiseröhre, ins- besondere aus dem Magen. Beitr Zur Klin Chir 1922;126:490–531.

    Google Scholar 

  2. Jianu A. Über Oesophagoplastik. Deutsch Zeitschr Chir 1914; 131:397–403.

    Google Scholar 

  3. Kirschner M. Ein neues Verfahren der Oesophagusplastik. Arch Klin Chir 1920;114:604–612.

    Google Scholar 

  4. Akiyama H, Hashimoto C. Resection and reconstruction for carcinoma of the thoracic oesophagus. Br J Surg 1976;63:206–209.

    Article  PubMed  CAS  Google Scholar 

  5. Gavrilyu D, Georgescu L. Esofagoplastie directacu material gastric. Rev Stiint Med 1951;3:33–36.

    Google Scholar 

  6. Heimlich HJ, Winfield JM. The use of gastric tube to replace or bypass the esophagus. Surgery 1955;37:549–559.

    PubMed  CAS  Google Scholar 

  7. Koskas F, Gaiet B. Anatomical study of retrosternal gastric esophagoplasties. Anat Klin 1985;7:237–256.

    Article  CAS  Google Scholar 

  8. Liebermann-Meffert DMI, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruc- tion. Ann Thorac Surg 1992;54:1110–1115.

    Article  PubMed  CAS  Google Scholar 

  9. Davydov MI, Nered SN, Kuzmichov VA, Volkov SM. Gastric esophagoplasty for esophageal carcinoma. Semin Surg Oncol 1992;8:9–15.

    PubMed  CAS  Google Scholar 

  10. Bemelman WA, Taat CW, Slors JFM, van Lanschot JJB, Obertop H. Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute. J Am Coll Surg 1995;180:461–464.

    PubMed  CAS  Google Scholar 

  11. Biichler MW, Baer HU, Seiler Ch, Schilling M. A technique for gastroplasty as substitute for the esophagus: Fundus rota- tion gastroplasty. J Am Coll Surg 1996;182:241–245.

    Google Scholar 

  12. Schilling MK, Mettler D, Redaelli C, Büchler MW. Circula- tory and anatomical differences between experimental gastric tubes as esophageal replacement. World J Surg 1997;21:992–997.

    Article  PubMed  CAS  Google Scholar 

  13. Schilling MK, Zbären H, Baer HU, et al.. First clinical expe- rience with fundus rotation gastroplasty as substitute for the esophagus. Br J Surg 1997;84:126–129.

    Article  PubMed  CAS  Google Scholar 

  14. Schilling MK, Redaelli C, Maurer Ch, Friess H, Büchler MW. Gastric microcirculatory changes during gastroplasty— assessment with laser Doppler nowmetry. J Surg Res 1996;62:125–129.

    Article  PubMed  CAS  Google Scholar 

  15. Schilling MK, Redaelli C, Krähenbühl L, et al.. Splanchnic mi- crocirculatory changes during CO2 laparoscopy. J Am Coll Surg 1997;184:378–382.

    PubMed  CAS  Google Scholar 

  16. Iwao T, Toyonaga A, Ikegami M, Oho K, Sumino M. Ob- server agreement and variability in measuring gastric mucosal blood flow by laser Doppler flowmetry in humans. Endoscopy 1993;25:274–277.

    Article  PubMed  CAS  Google Scholar 

  17. Krohg-Sorensen K, Line PD, Haaland T, Horn RS, Kvernebo K. Intraoperative prediction of ischaemic injury of the bowel: A comparison of laser Doppler flowmetry and tissue oximetry to histological analysis. Eur J Vasc Surg 1992;6:518–524.

    Article  PubMed  CAS  Google Scholar 

  18. Goldsmith HS, Akiyama H. A comparative study of Japanese and American gastric dimensions. Ann Surg 1979;190:690–693.

    PubMed  CAS  Google Scholar 

  19. Pearson FG, Henderson RD. Experimental and clinical stud- ies of gastroplasty in the management of acquired short esoph- agus. SurgGynecol Obstet 1973;136:737–744.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral and Transplantation Surgery and the Surgical Research Unit (D.M.), University of Bern, Inselspital, Bern, Switzerland

    Martin K. Schilling M.D. & Daniel Mettler D.V.M.

Authors
  1. Martin K. Schilling M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Mettler D.V.M.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Feodorovici M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus W. Büchler M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin K. Schilling M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schilling, M.K., Mettler, D., Feodorovici, M. et al. Organ-preserving resection of the gastroesophageal junction and substitution with a gastric corpus rotation tube: an experimental study. J Gastrointest Surg 4, 63–69 (2000). https://doi.org/10.1016/S1091-255X(00)80034-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(00)80034-7

Key words

Search

Navigation