A method of valvuloplastic esophagogastrostomy to prevent reflux after proximal gastrectomy

Abstract

This is a report of our new method of valvuloplastic esophagogastrostomy for the prevention of postoperative reflux esophagitis, and the clinical results in 10 patients. After proximal resection of the stomach, the medial side of the cut end of the gastric remnant is closed in the usual fashion. The mucosal layer of the lateral side of the gastric remnant is partially closed, but the seromuscular layers are left open. The esophagus is anastomosed to the gastric remnant mucosa, which is inverted so as to form a mucosal valve. The seromuscular layers of the gastric remnant are then wrapped around the distal esophagus, similar to a Nissen fundoplication, so as to create an artificial fundus. The intragastric esophageal wall facing the fundus acts as a long one-way flap valve to prevent reflux. The 10 patients who have undergone valvuloplastic esophagogastrostomy have remained free of postoperative complications due to reflux. X-ray fluoroscopy and esophagoscopy done at the time of discharge from the hospital revealed no evidence of reflux or esophagitis. Withdrawal pH studies performed in 5 of the patients showed a sharp rise in pH starting at the site of the anastomosis. Withdrawal intraluminal pressure studies performed in 7 patients showed a high pressure zone with a mean pressure of 11.3 mm Hg and a mean length of 4.0 cm. These results indicate that the new method of esophagogastrostomy effectively prevented postoperative reflux esophagitis after conventional methods of proximal gastric resection.

Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy

“…Attempts to add a valve-like mechanism to prevent reflux after esophagogastrostomy have been reported since 1964 [2,3]. However, despite the many reports that have been published on this topic [4][5][6][7][8][9][10], no optimal method of anastomosis has come into wide use because of problems associated with the reliability of reflux prevention, the occurrence of anastomotic stenosis, and technical difficulties.…”