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The split-stomach fundoplication after esophagogastrectomy

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Two complications associated with esophagogastrectomy are anastomotic leak and gastroesophageal re flux. We describe here a modification of an intrathoracic esophagogastrostomy using the gastric fundus to address these issues. After completion of the esophagogastrectomy, the fundus is divided to produce “wings.” After the esophagogastrostomy is performed, the wings are used to form a wrap around the anastomosis. This wrap is secured to the esophagus and to the stomach. All patients undergoing the split-stomach fundoplication were compared with all patients undergoing standard esophagogastrectomies. End points were in-hospital mortality, anastomotic leak, and postoperative endoscopic dilation. All living patients were contacted and questioned about refluxlike symptoms and completed the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) symptom severity questionnaire. Twenty-six patients underwent the split-stomach fundoplication (wrap group), compared to 54 patients undergoing standard resection (no wrap group). Occurrence of end points in the wrap vs. no wrap groups were, respectively, in-hospital mortality, 3.8% vs. 7.4% (P = NS); anastomotic leak, 0% vs. 17% (P = 0.03); reflux symptoms 20% vs. 60% (P = 0.001); postoperative dilation, 40% vs. 30% (P = NS). The median total GERD-HRQL score was 5 for the wrap group vs. 14 for the no wrap group (P = 0.03). The addition of the split-stomach fundoplication to esophagogastrectomy may decrease the incidence of anastomotic leak and postoperative refluxlike symptoms.

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References

  1. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 2004;198:42–50.

    Article  PubMed  Google Scholar 

  2. Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: Risk factors and management. J Am Coll Surg 2002;194:285–297.

    Article  PubMed  Google Scholar 

  3. Crestanello JA, Deschamps C, Cassivi SD, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 2005; 129:254–260.

    Article  PubMed  Google Scholar 

  4. Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: Gastric pull-up versus colon interposition. J Am Coll Surg 2004;198:536–542.

    Article  PubMed  Google Scholar 

  5. Ercan S, Rice TW, Murthy SC, Rybicki LA, Blackstone EH. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg 2005; 129:623–631.

    Article  PubMed  Google Scholar 

  6. Law S, Suen DT, Wong KH, Kwok KF, Wong J. A singlelayer, continuous, hand-sewn method for esophageal anastomosis: Prospective evaluation in 218 patients. Arch Surg 2005;140:33–39.

    Article  PubMed  Google Scholar 

  7. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: Outcomes in 222 patients. Ann Surg 2003;238:486–494.

    PubMed  Google Scholar 

  8. Blewett CJ, Miller JD, Young JE, Bennett WF, Urschel JD. Anastomotic leaks after esophagectomy for esophageal cancer: A comparison of thoracic and cervical anastomoses. Ann Thorac Cardiovasc Surg 2001;7:75–78.

    PubMed  CAS  Google Scholar 

  9. Rindani R, Martin CJ, Cox MR. Transhiatal versus IvorLewis oesophagectomy: Is there a difference? ANZ J Surg 1999;69:187–194.

    Article  CAS  Google Scholar 

  10. Boyle MJ, Franceschi D, Livingstone AS. Transhiatal versus transthoracic esophagectomy: Complication and survival rates. Am Surg 1999;65:1137–1141.

    PubMed  CAS  Google Scholar 

  11. Sauvanet A, Baltar J, LeMeeJ, Belghiti J. Diagnosis and conservative management of intrathoracic leakage after oesophagectomy. Br J Surg 1998;85:1446–1449.

    Article  PubMed  CAS  Google Scholar 

  12. Aly A, Jamieson GG. Reflux after oesophagectomy. Br J Surg 2004;91:137–141.

    Article  PubMed  CAS  Google Scholar 

  13. Dresner SM, Griffin SM, WaymanJ, Bennett MK, Hayes N. Human model of duodenogastro-oesophageal reflux in the development of Barrett’s metaplasia. Br J Surg 2003;90:1120–1128.

    Article  PubMed  CAS  Google Scholar 

  14. Lerut TE, van Lanschot JJ. Chronic symptoms after subtotal or partial oesophagectomy: Diagnosis and treatment. Best Practice Res Clin Gastroenterol 2004;18:901–915.

    Article  CAS  Google Scholar 

  15. Shibuya S, Fukudo S, Shineha R, et al. High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg 2003;27:580–583.

    Article  PubMed  Google Scholar 

  16. Johansson J, Johnsson F, Groshen S, Walther B. Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses. J Thorac Cardiovasc Surg 1999; 118:1078–1083.

    Article  PubMed  CAS  Google Scholar 

  17. Borst HG, Dragojevic D, Stegmann T, Hetzer R. Anastomotic leakage, stenosis, and reflux after esophageal replacement. World J Surg 1978;2:861–864.

    Article  PubMed  CAS  Google Scholar 

  18. McKeown KC. Total oesophagectomydthree staged resection. In: Jamieson GG, ed. Surgery of the Oesophagus. Edinburgh: Churchill Livingstone, 1988, pp 677–685.

    Google Scholar 

  19. Yalav E, Ercan S. Reservoir and globe-type antireflux surgical techniques in intrathoracic esophagogastrectomies. Dis Esophagus 2000;13:282–287.

    Article  PubMed  CAS  Google Scholar 

  20. Okada N, Kuriyama T, Umemoto H, Komatsu T, Tagami Y. Esophageal surgery: A procedure for posterior invagination esophagogastrostomy in one-stage without positional change. Ann Surg 1974;179:27–34.

    PubMed  CAS  Google Scholar 

  21. Aly A, Jamieson GG, Pyragius M, Devitt PG. Antireflux anastomosis after oesophagectomy. ANZ J Surg 2004;74:434–438.

    Article  PubMed  CAS  Google Scholar 

  22. Velanovich V. Esophagogastrectomy without pyloroplasty. Dis Esophagus 2003;16:243–245.

    Article  PubMed  CAS  Google Scholar 

  23. Velanovich V. Comparison of generic (SF-36) vs. diseasespecific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg 1998;2:141–145.

    Article  PubMed  CAS  Google Scholar 

  24. Taylor EW, Alexander-Williams J. Radical total gastrectomy for carcinoma. In: Nyhus LM, Baker RJ, eds. Mastery of Surgery. Boston: Little, Brown and Co, 1984, pp 572–581.

    Google Scholar 

  25. DeMeester TR. Transthoracic antireflux procedures. In: Nyhus LM, Baker RJ, eds. Mastery of Surgery. Boston: Little, Brown and Co, 1984, pp 381–392.

    Google Scholar 

  26. Streets CG, DeMeester SR, DeMeester TR, et al. Excellent quality of life after Nissen fundoplication depends on successful elimination of reflux symptoms and not the invasiveness of the surgical approach. Ann Thorac Surg 2002;74:1019–1025.

    Article  PubMed  Google Scholar 

  27. Mathew G, Myers JC, Watson DI, Devitt PG, Jamieson GG. Motility across esophageal anastomoses after esophagectomy or gastrectomy. Dis Esophagus 1999; 12:276–282.

    Article  PubMed  CAS  Google Scholar 

  28. O’Riordan JM, Tucker ON, Byrne PJ, et al. Factors influencing the development of Barrett’s epithelium in the esophageal remnant postesophagectomy. Am J Gastroenterol 2004;99:205–211.

    Article  PubMed  CAS  Google Scholar 

  29. Oberg S, Johansson J, Wenner J, Walther B. Metaplastic columnar mucosa in the cervical esophagus after esophagectomy. Ann Surg 2002;235:338–345.

    Article  PubMed  Google Scholar 

  30. Heitmiller RF, Fischer A, Liddicoat JR. Cervical esophagogastric anastomosis: Results after esophagectomy for carcinoma. Dis Esophagus 1999;12:264–269.

    Article  PubMed  CAS  Google Scholar 

  31. Karl RC, Schreiber R, Boulware D, Baker S, Coppola D. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 2000;231:635–643.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of General Surgery, K-8, Henry Ford Hospital, 2799West Grand Blvd., 48202-2689, Detroit, MI

    Vic Velanovich M.D. & Nathan Mohlberg B.S.

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  1. Vic Velanovich M.D.
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  2. Nathan Mohlberg B.S.
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Correspondence to Vic Velanovich M.D..

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Velanovich, V., Mohlberg, N. The split-stomach fundoplication after esophagogastrectomy. J Gastrointest Surg 10, 178–185 (2006). https://doi.org/10.1016/j.gassur.2005.10.014

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