Reservoir and globe-type antireflux surgical techniques in intrathoracic esophagogastrostomies

Abstract

Gastroesophageal re¯ux is a major postoperative problem in esophageal patients with cancer, and the principal cause is resection of the lower esophageal sphincter. Two new antire¯ux operations to solve this problem were investigated. The number of patients studied was 139, with a male to female ratio of 5. The reservoir technique was applied to the ®rst 50 patients and the globe technique was used in the remaining 89. Hospital mortality was 9.35%. Patient satisfaction from a re¯ux standpoint was excellent in 91.4%, good to fair in 6.5%, and poor in 2.1%. Postoperative barium swallow at the ®rst, third, and sixth months showed no re¯ux in 93% of cases. Postoperative preanastomotic mean pressure was 14.2 mmHg. Postoperative mucosal biopsies revealed a remarkable reduction in esophagitis. The radiologic, manometric, and histologic ®ndings as well as the patient satisfaction rate suggest that these antire¯ux operations are suitable and eective for patients undergoing esophageal resection and intrathoracic esophagogastric anastomosis.

An Antireflux Anastomosis Following Esophagectomy: A Randomized Controlled Trial

“…A number of surgical techniques attempting to control reflux after esophagectomy have been reported 5 including intercostal muscle grafts to act as anti-reflux valves, 21 tunneling the esophagus through the muscular layer of the stomach 22,23 "inkwelling" 24,25 or creating a "globe" posteriorly invaginated anastomosis. 26 None have been subjected to a randomized controlled study and have historically been described in the setting of limited or palliative resections offering a substantial esophageal and or gastric remnantsomething not available after modern radical resection for cancer. 27 The use of colonic interposition after esophageal resection eliminates gastro-duodenal secretions and, therefore, reflux.…”

Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy

“…Other studies show a variation from 27 to 42% or more in the occurrence of anastomotic stenosis, esophageal-gastric patients undergoing esophagectomy 16 , showing that the incidence observed in our study is in agreement with the literature. In eletromanometric study, we observed that the average pressure of the anastomosis in the patients studied was 7.55mmHg, while Yalav and Ercan 4 showed an average pressure of 14.2mmHg in cases of intra-thoracic anastomosis with performance of antireflux valve in order to reduce aggression to the esophageal stump. In our study, although the lower average, the anastomosis is near the upper esophageal sphincter, which showed an average pressure of 24.83mmHg which seems to favor the prevention of the occurrence of gastroesophageal reflux.…”

“…The chagasic megaesophagus has as its main pathological findings a strong intramural denervation that affects the almost entirely the middle and lower esophageal There are several reports in the literature about the anatomical and functional changes of the remaining esophageal stump after subtotal esophagectomy, especially in the treatment of esophageal cancer 4 . However, for the treatment of achalasia reports are still few, which encouraged us to investigate these possible changes 5 .…”

Surgical attempts to avoid anastomotic leaks and reduce reflux esophagitis following esophagectomy for cancer

“…The upper bar represents the incidence in patients whose corrected anastomotic height was less than 0.154 (median value); the lower bar represents the incidence in patients whose corrected anastomotic height was more than 0.154 68% of the ITA patients had to sleep in an upright position because of refl ux problems. Several anastomotic techniques have been used to construct a new antirefl ux barrier after resection of an esophagogastric junction [21][22][23][24]. The technique that we used with the ITA was similar to the reservoir technique introduced by Yalav et al [24].…”

“…Several anastomotic techniques have been used to construct a new antirefl ux barrier after resection of an esophagogastric junction [21][22][23][24]. The technique that we used with the ITA was similar to the reservoir technique introduced by Yalav et al [24]. Self-evaluations by the patients in that study on the severity of postoperative refl ux symptoms were excellent, with no symptoms of refl ux being reported by 91% of the patients who underwent the reservoir technique or another antirefl ux technique.…”