Reflux after oesophagectomy

Abstract

Reflux after oesophagectomy is a significant problem, with both clinical and pathological consequences. Simple measures to facilitate gastric emptying, such as creating a gastric tube, performing a pyloric drainage procedure and using gastric motility agents, may produce a reduction in symptoms but do not alone control reflux itself. A variety of surgical reconstructions have been used, many of which are either difficult to fashion or not suitable when a radical resection has been performed. A modified fundoplication at the anastomosis seems to be the simplest technique and may be relatively effective in controlling symptoms. The impact of strategies to reduce reflux on quality of life and on pathological sequelae of reflux in the oesophageal remnant remains to be evaluated.

Ivor–Lewis oesophagogastrectomy with Roux-en-Y duodenal bypass

“…11 The majority (60-80%) of patients who have had an oesophagectomy will have reflux symptoms following the procedure. 8 Many of these will develop a chronic cough and recurrent pneumonia associated with the refluxing acid. 12 Importantly, patients can also go on to develop Barrett's oesophagus in their residual oesophageal stump.…”

“…However, the desired results have not been forthcoming. 8 Faced with three oesophagectomies to perform for benign disease and wanting not only optimal long-term function but also good quality of life, we decided to modify the standard gastric interposition procedure. A Roux-en-Y duodenal bypass was added to the gastric tube pull-up procedure, an established method of reconstruction in gastric and bariatric surgery.…”

Mini Review on Important Biological Properties of Benzofuran Derivatives

“…The neolignans and lignans are having various types of biological activities like immune-suppressive, anticancer, antiviral, antioxidant, antifeedant and anti-fungal activities. Amiodarone is a highly effective antiarrhythmic agent [2]. The 2-substituted benzofurans have received a great interest for their anti-HIV [3], anticancer and anti-microbial [4][5][6][7] activities.…”

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“…The potential postoperative complications (reflux, regurgitation, early satiety, dumping syndrome, and dysphagia) should be discussed with the patient prior to the day of surgery. Possible complications in the early postoperative period include the risk of violation of the anastomosis and pulmonary complications are caused by aspiration, which can lead to serious complications and respiratory infections [2]. Many of these are caused by delayed gastric tube emptying and dilatation.…”

“…Bilateral truncal vagotomy performed during esophagectomy can lead to delayed gastric empting. When clinically significant delayed emptying occurs, it is associated with increased morbidity [2] theoretically, a gastric drainage procedure should solve the problem. That is why pyloroplasty has been advocated as an adjunct to esophagectomy to avoid delayed gastric emptying [4,5].…”