How Important Is The Route of Reconstruction After Esophagectomy: A Prospective Randomized Study

Gawad, Karim A.; Hosch, Stefan B.; Bumann, D; Lübeck, M.; Moneke, L.C; Bloechle, C.; Knoefel, Wolfram Trudo; Busch, Christoph; Küchler, Th.; Izbicki, Jakob R.

doi:10.1111/j.1572-0241.1999.01131.x

Cited by 86 publications

(43 citation statements)

References 22 publications

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“…In the literature, a pyloric drainage procedure is known to have an unclear effect on reflux [3-5,9,10]. In the present study, the degree of DGR had the definitive tendency to be higher in a gastric tube with a larger pyloric opening.…”

Section: Discussionsupporting

confidence: 48%

“…Controversy still exists about the omission of a pyloric drainage procedure and the use of an extra-anatomical route because the evidence from the literature is conflicting [4,5,9-12]. A reason for these conflicting results is that the clinical data from human subjects is not easily reproducible due to many other factors that affect DGR and cannot be completely controlled in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

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A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition

Park

Lee

Sung

et al. 2013

J Cardiothorac Surg

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BackgroundOur goal was to verify surgical factors that affect duodenogastric reflux (DGR) after esophagectomy through the use of a flow visualization model that would mimic an intrathoracic gastric tube.MethodsTransparent gastric tube models for different routes (retrosternal space [RS] and posterior mediastinum [PM]) were fabricated. Various distal pressures were applied to the experimental model filled with water, and the flow was recorded with a high-speed camera. The volume and maximum height of the refluxate through the pylori of two different sizes (7.5 mm, 15 mm) in two different postures (upright, semi-Fowler) was measured by analyzing the video clips.ResultsFor the large pylorus setting, when the pressures of 20, 30, and 40 mmHg were applied in the upright position, the volumes of the refluxate in the RS/PM tubes were 87.7 ± 1.1/96.4 ± 1.7 mL, 150.8 ± 1.1/158.0 ± 3.2 mL, and 156.8 ± 3.3/198.0 ± 4.7 mL (p < 0.05), and the maximum heights were 101.6 ± 4.8/113.4 ± 2.9 mm, 151.4 ± 2.2/165.4 ± 1.5 mm, and 166.1 ± 1.7/193.7 ± 6.6 mm (p < 0.05). The data for the small pylorus setting or in the semi-Fowler position showed similar tendencies. For any given route, posture or pressure setting, DGR in the large pylorus model was definitively higher than that for small one.ConclusionsThis fluid mechanics study demonstrates posterior mediastinal gastric interposition or pyloric drainage procedure, or both, is associated with high reflux of duodenal contents.

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Section: Discussionsupporting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition

Park

Lee

Sung

et al. 2013

J Cardiothorac Surg

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“…Imada et al 29 observed equivalent absorption in both treatment arms in their study, although emptying may be slower when the conduit is positioned retrosternally. 30…”

Section: Discussionmentioning

confidence: 99%

Esophagectomy for complications of esophageal intramural pseudodiverticulosis

Thibodeau

Brigand

Ferraro

et al. 2007

Diseases of the Esophagus

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This report describes the clinical course of a patient with complications of esophageal intramural pseudodiverticulosis. The condition led to fistulization and abscess formation in the mediastinum. The initial presentation was for the septic process and appropriate antibiotic therapy led to infection control while the abscess drained spontaneously back into the esophageal lumen. A long stricture affecting the distal half of the esophagus became evident after a few months and could not be managed by repeat dilatations. After appropriate preparation, subtotal esophagectomy was offered to the patient with an initial right thoracic approach followed by laparotomy and left cervical reconstruction. A total gastric tube was used for reconstruction and placed in a substernal position. An uneventful postoperative evolution led to normal swallowing comfort.

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“…Extra-anato mical esophageal reconstruction offers the advantage that a recurrent intrath oracic tu mor mass will not invade the neo-esophagus [2] [3]. In addition, an extra-anato mical gastric interposition may also be used to bypass a corrosive esophageal injury.…”

Section: Introductionmentioning

confidence: 99%

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

Hashimoto¹

2014

OALib

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Stomach is considered the "gold standard" as an esophageal substitute after esophagectomy. Reflux disease is considered an unavoidable consequence of esophageal resection followed gastric interposition. Reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. With the use of a gastric interposition, the m ost popular option to reconstruct the esophagus resected for malignant or benign conditions creates an in vivo model of reflux disease. Gastric interposition is far from ideal as an esophageal substitute. R eflux esophagitis and new columnar lined metaplasia should be seen as a new complication of subtotal esophagectomy.

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How Important Is The Route of Reconstruction After Esophagectomy: A Prospective Randomized Study

Abstract: The posterior mediastinal route of reconstruction is recommended but curative resection (R0) is mandatory to avoid possible complications due to local tumor relapse. After incomplete resection (R1 or R2) we recommend retrosternal reconstruction for better palliation.

Cited by 86 publications

References 22 publications

A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition

A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition

Esophagectomy for complications of esophageal intramural pseudodiverticulosis

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

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