Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy

Matsushiro, Takashi; Hariu, Tsuneo; Nagashima, Hiroshi; Yamamoto, Koichiro; Imaoka, Yuki; Yamagata, Ryo; Okuyama, Shuhei; H, Mishina

doi:10.1016/0002-9610(86)90265-5

Cited by 22 publications

(16 citation statements)

References 5 publications

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“…If the gastric remnant is considered less than 2/3 of the original stomach after PG, then reconstruction should be performed not by esophagogastrostomy but rather by interposition of a jejunal limb or inverted U-shaped jejunal pouch. Valvuloplasty and pyloroplasty after PG was proposed by Matsushiro et al (1986) in an attempt to prevent reflux of intraluminal contents from the stomach into the esophagus. Although satisfactory clinical results have been reported after this procedure (Imaoka et al 1991), the created valve did not function well in our patient.…”

Section: Discussionmentioning

confidence: 99%

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Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Someya

Shibata

Tanaka

et al. 2013

Tohoku J. Exp. Med.

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Reflux gastroesophagitis is a common postgastrectomy complication after proximal gastrectomy, and conservative treatments including protease inhibitors and proton pump inhibitors are effective in most patients. Here we report a patient with severe reflux gastroesophagitis after proximal gastrectomy, in whom surgical treatment of duodenal switch was effective. An 80-year-old man complained of intractable heartburn, anorexia, and body weight loss after having undergone proximal gastrectomy, with reconstruction by esophagogastrostomy with valvuloplasty and pyloroplasty, for early gastric cancer 14 months before referral to our department. Oral administration of protease inhibitors and proton pump inhibitors was ineffective. Laboratory evaluation showed poor nutritional status. On endoscopic examination, we noted the redness, bleeding, and multiple erosions in the esophagus and the gastric remnant. He was diagnosed to have severe gastroesophagitis due to reflux of duodenal juice into the gastric remnant and esophagus. We performed duodenal switch to divert duodenal juice from the gastric remnant and esophagus; the duodenum was transected 2 cm distal to the pylorus, the duodenal distal end was closed, and a 50-cm Roux limb from the proximal jejunum was anastomosed to the proximal end of the duodenum. The heartburn disappeared postoperatively, and endoscopic examination revealed marked improvement of the reflux gastroesophagitis. One year postoperatively, the patient is free from symptoms including heartburn. His body weight increased, and laboratory data showed improvement in nutritional status. In conclusion, the duodenal switch may be surgical treatment of choice for intractable reflux gastroesophagitis after proximal gastrectomy.

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Section: Discussionmentioning

confidence: 99%

“…Reconstruction of the alimentary tract was by esophagogastrostomy with valvuloplasty and pyloroplasty (Matsushiro et al 1986). The remnant stomach was vagally-denervated because of perigastric lymph node dissection.…”

Section: Clinical Reportmentioning

confidence: 99%

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Someya

Shibata

Tanaka

et al. 2013

Tohoku J. Exp. Med.

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“…It has been shown that independent prognostic factors such as ensuring radical cure, maintaining food passage in the duodenum, and less excision of the stomach, are very important for postoperative QOL [17,18] . A high incidence of reflux symptoms after simple esophagogastrostomy has prompted the development of several novel reconstructions to prevent reflux [12,[19][20][21] . Previous reports have shown that proximal gastrectomy is more likely to produce complications such as heartburn and poor appetite, and worsen nutritional status compared to other types of gastrectomy [22] .…”

Section: Discussionmentioning

confidence: 99%

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Zhang¹,

Sun²,

Xu³

et al. 2009

WJG

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AIM:To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal gastrectomy.METHODS: QOL assessments that included functional outcomes (a 24-item survey about treatmentspecific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional esophagogastrostomy. RESULTS:Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three groups. CONCLUSION:Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.

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“…Like the present authors, several investigators have postulated that direct anastomosis between the esophagus and the remnant stomach result in significant gastroesophageal reflux, and subsequently, to various degrees of esophagitis and stricture (18,19). To avoid this, esophagogastrostomy such as valvuloplasty plus fundoplasty (20), gastric tube reconstruction (21), jejunal interposition (22), and jejunal pouch interposition (23) were devised. Although these procedures are complicated and time-consuming, we have used the jejunal pouch interposition as the usual reconstruction method following proximal gastrectomy since 2000, and a prospective study currently is ongoing as part of our continuing efforts to assure the efficacy of proximal gasrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach.…”

Section: Discussionmentioning

confidence: 99%

Issues in the Management of the Upper Third Gastric Cancer

Yang

2004

Cancer Res Treat

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Purpose: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions.Materials and Methods: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively.Results: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2% ) and anastomotic stricture (35.1% ) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8% ) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor.Conclusion: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

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Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy

Cited by 22 publications

References 5 publications

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Duodenal Switch for Intractable Reflux Gastroesophagitis after Proximal Gastrectomy

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Issues in the Management of the Upper Third Gastric Cancer

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