Introduction of a method of valvuloplastic esophagogastrotomy in proximal gastrectomy

A technique of valvuloplastic esophagogastrostomy is proximal gastrectomy to control postoperative reflux esophagitis is reported. After proximal resection of the stomach, the medial stump is closed in two layers. The mucosal layers of the lateral stump are sewn but leaving the seromuscular layers open. The esophagus is anastomosed to the mucosal stoma at the middle of the gastric stump. The distal esophagus is wrapped by the lateral stump like Nissen's fundoplication to create the artificial fundus. Intragastric esophageal wall facing the fundus acts as a long one-way flap valve to prevent reflux. Ten dogs were prepared with this method and were compared with end-to-end and end-to-side anastomosis prepared in five dogs each. Cinefluoroscopy and esophageal pH demonstrated various degress of reflux in all the dogs with end-to-end and end-to-side anastomosis, and mild reflux in one out of the ten dogs with valvular anastomosis. A sharp rise in pH at the anastomotic site was consistent in the remaining nine valvuloplastic dogs. High pressure zone, 9.9 mmHg on an average at the site of anastomosis was present in valvuloplastic dogs, while the pressure was 0 mmHg in end-to-end and 5.2 mmHg in end-to-side anastomosis dogs. Clinical application of this procedure in ten patients obtained satisfactory results. The technique offers a reliable method of valvuloplastic anastomosis in esophagogastrostomy.