Intercostal pedicle method for control of postresection esophagitis. Thirteen-year clinical study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• Gastroesophageal reflux esophagitis poses a significant clinical challenge.
• Surgical interventions are explored to manage severe reflux and its complications.
• Esophagogastrostomy is a common procedure for esophageal cancer and strictures.

Purpose of the Study:

• To evaluate the efficacy of the intercostal pedicle technique in preventing reflux after esophagogastrostomy.
• To assess the long-term outcomes of patients who underwent this experimental surgical method.
• To determine the technique's effectiveness in managing various esophageal conditions.

Main Methods:

• Application of the intercostal pedicle method in 43 patients over 13 years.
• Patient cohort included those with esophagogastrectomy for cancer, palliative esophagogastrostomy, and esophageal stricture.
• Follow-up utilized esophagography, fluoroscopy, fiberoptic esophagoscopy, motility, and pH studies.

Main Results:

• No symptoms of regurgitation or reflux reported in any patient.
• No esophageal stricture observed postoperatively, with one patient requiring initial dilatations.
• Esophageal manometry showed a stable lower esophageal sphincter pressure (12-15 mm Hg) and alkaline pH.
• Successful management of anastomotic leaks was noted in two patients.

Conclusions:

• The intercostal pedicle technique is a highly effective method for preventing gastroesophageal reflux in patients undergoing esophagogastrostomy.
• This technique demonstrates excellent long-term outcomes, including symptom resolution and prevention of complications like strictures.
• The study recommends the intercostal pedicle technique for all chest esophagogastrostomies.