The split-stomach fundoplication after esophagogastrectomy.

Area of Science:

• Surgical Innovation
• Gastroenterology
• Oncology

Background:

• Esophagogastrectomy is associated with significant complications like anastomotic leak and gastroesophageal reflux.
• Current surgical techniques aim to minimize these adverse outcomes.
• Reflux-like symptoms and leaks negatively impact patient quality of life post-surgery.

Purpose of the Study:

• To introduce and evaluate a modified intrathoracic esophagogastrostomy using gastric fundus "wings" for reconstruction.
• To assess the efficacy of this "wrap" technique in reducing anastomotic leaks and reflux symptoms.
• To compare outcomes of the modified technique against standard esophagogastrectomy.

Main Methods:

• A retrospective comparison of patients undergoing split-stomach fundoplication (wrap group, n=26) versus standard esophagogastrectomy (no wrap group, n=54).
• Evaluation of in-hospital mortality, anastomotic leak rates, and need for postoperative dilation.
• Assessment of reflux symptoms and quality of life using the GERD-HRQL questionnaire.

Main Results:

• The wrap group showed a significantly lower anastomotic leak rate (0% vs. 17%, P=0.03).
• Reflux symptoms were markedly reduced in the wrap group (20% vs. 60%, P<0.001) with a lower median GERD-HRQL score (5 vs. 14, P=0.03).
• In-hospital mortality and need for dilation were not significantly different between groups.

Conclusions:

• Split-stomach fundoplication is a promising modification to reduce anastomotic leak and reflux after esophagogastrectomy.
• This technique may improve postoperative outcomes and patient quality of life.
• Further prospective studies are warranted to confirm these findings.