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Related Experiment Videos

Reflux esophagitis after proximal subtotal gastrectomy

C Y Wang1, H K Hsu, H C Chang

  • 1Department of Surgery, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.

Zhonghua Yi Xue Za Zhi = Chinese Medical Journal; Free China Ed
|June 1, 1997
PubMed
Summary

Proximal subtotal gastrectomy for cardia cancer often leads to severe reflux esophagitis, despite anti-reflux surgery. This procedure is not recommended due to high rates of gastroesophageal reflux and esophagitis post-operation.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Esophageal Surgery

Background:

  • Carcinoma of the cardia or esophagocardiac junction has a poor prognosis.
  • Proximal subtotal gastrectomy is a surgical option for smaller tumors, aiming for outcomes similar to total gastrectomy with better functional results.
  • Clinical observations revealed frequent symptoms of reflux esophagitis after this procedure.

Purpose of the Study:

  • To reevaluate patients who underwent proximal subtotal gastrectomy and experienced reflux esophagitis.
  • To assess the efficacy of floppy Nissen's fundoplication as an anti-reflux procedure in conjunction with proximal subtotal gastrectomy.

Main Methods:

  • Twenty patients who received proximal subtotal gastrectomy between November 1990 and March 1996 were studied.

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  • Floppy Nissen's fundoplication was performed as an anti-reflux measure during surgery.
  • Continuous 24-hour pH monitoring, esophageal manometry, and endoscopic examinations were utilized for evaluation.

    • Main Results:

    • 80% of patients developed reflux esophagitis, confirmed by endoscopy.
    • Patients exhibited significantly higher pH scores, lower lower esophageal sphincter (LES) pressure, and shorter intra-abdominal LES lengths compared to normal values.
    • These findings indicate a failure of the anti-reflux procedure and significant gastroesophageal reflux post-surgery.

    Conclusions:

    • Floppy Nissen's fundoplication was ineffective in preventing reflux esophagitis after proximal gastric resection.
    • Severe gastroesophageal reflux is a common complication following proximal subtotal gastrectomy.
    • The short gastric remnant often precludes effective anti-reflux wrapping, thus proximal subtotal gastrectomy is not advised for early cardia cancer.