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Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
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ANATOMIC DAMAGE OF THE LOWER ESOPHAGEAL SPHINCTER AFTER SUBTOTAL GASTRECTOMY
Owen Korn1, Attila Csendes1, Patricio Burdiles1
1Department of Surgery, Clinical Hospital University of Chile, Santiago, Chile.
Summary
Subtotal gastrectomy alters lower esophageal sphincter (LES) pressure by transecting its sling fibers. Surgical closure of the gastric remnant impacts LES pressure, potentially causing reflux and esophagitis.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Esophageal Physiology
Background:
- Subtotal gastrectomy is associated with lower esophageal sphincter (LES) dysfunction, gastroesophageal reflux disease, and erosive esophagitis.
- The underlying causes of these post-gastrectomy complications remain unclear.
Purpose of the Study:
- To investigate the hypothesis that subtotal gastrectomy alters LES resting pressure and competence.
- To determine if transection of the oblique "Sling" fibers during surgery contributes to these changes.
Main Methods:
- Seven dogs underwent subtotal gastrectomy with proximal stomach transection and closure.
- Lower esophageal sphincter (LES) manometry was performed before and after the surgical procedure.
- Each dog served as its own control to compare LES pressure measurements.
Main Results:
- Mean LES pressure decreased in five dogs, increased in one, and remained unchanged in others post-surgery.
- Variations in LES pressure suggest that surgical manipulation impacts LES function.
Conclusions:
- Transection and subsequent closure of the proximal stomach remnant alter LES pressure.
- These alterations are likely due to the disruption and re-anchoring of the LES "Sling" fibers.
- The degree of tension during surgical closure influences the resulting LES pressure.
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