Anti-reflux pouch-esophagostomy after total gastrectomy

Area of Science:

• Surgical Innovation
• Gastroenterology
• Oncology

Background:

• Severe reflux esophagitis is a significant complication following total gastrectomy.
• Current surgical techniques may not fully prevent postoperative reflux.

Purpose of the Study:

• To introduce and evaluate a novel jejunal pouch-esophagostomy procedure with partial posterior wrapping.
• To assess the efficacy of this technique in minimizing reflux esophagitis after total gastrectomy.

Main Methods:

• A 35 cm jejunal segment was folded, creating a side-to-side jejuno-jejunostomy.
• An esophago-jejuno anastomosis formed an "apical bridge" for partial posterior fundoplication-like wrapping.
• The procedure was performed as part of total gastrectomy.

Main Results:

• Barium meal testing revealed minimal postoperative reflux, even in the Trendelenburg position.
• The novel anti-reflux anastomosis procedure demonstrated significant efficacy.

Conclusions:

• Jejunal pouch reconstruction with partial posterior wrapping is a valuable addition to total gastrectomy.
• This technique effectively minimizes the risk of reflux esophagitis, enhancing patient recovery.