J.Jpn. Surg. Soc.. 78(2): 132-147, 1977

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Original article

STUDIES ON THE METHODS OF ESOPHAGOGASTROSTOMY AND POSTOPERATIVE REFLUX IN PROXIMAL GASTRECTOMY

When proximal gastrectomy is indicated for the lesion of the upper stomach, possible development of reflux esophagitis due to operative ablation of the cardial function has been a problem. Reviewing the cases underwent proximal gastrectomy with conventional end-to-end or end-to-side esophagogastrostomy, it has been noticed that half a number of the cases demonstrated the evidence of gastroesophageal reflux. Based on these facts, efficacy of our new valvuloplastic esophagogastrostomy has been evaluated experimentally and later in some clinical cases.
A total of 52 mongrel dogs were divided into three groups and were subjected to proximal gastrectomy with end-to-end, end-to-side and valvuloplastic anastomosis each for one of the three groups. After at least four weeks of recovery period, withdrawal pH and pressure recording as well as barium swallow were attempted for each group of dogs.
Analysis of the results was made out of 20 dogs which could be subjected to all the three tests as described above. Incidences of reflux attested by pH and pressure studies as well as cinefluoroscopy were 100% with end-to-end anastomosis (5 dogs), 60% with end-to-side anastomosis (5 dogs) and only 10% among 10 dogs with valvuloplastic anastomosis. Results of the same studies in 15 clinical cases were as follows. All the three cases with end-to-end anastomosis showed free reflux. Out of 10 cases with end-to-side anastomosis, four demonstrated moderate to mild reflux. Two cases with valvuloplastic anastomosis were free from reflux.
The results obtained are summarized as follows. Conventional end-to-end and end-to-side anastomoses allowed various degree of reflux both in experimental and clinical studies. In this regard, our method of valvuloplastic anastomosis yielded best results in preventing reflux in both experimental and clinical evaluation.

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