Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses

• OBJECTIVE: Pharyngeal reflux after a gastric pull-up esophagectomy may cause aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric pull-up esophagectomy and evaluates the impact of additional dissection of the esophagus that is necessary for neck anastomoses versus no neck exploration and proximal chest anastomoses.METHODS: Forty-seven patients had circular stapled anastomoses in the apex of the right chest (n = 27 patients) or manually sutured neck anastomoses (n = 20 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent time pH less than 4 was registered 3, 6, and 12 months after the operation.RESULTS: Mean acid exposure to the proximal pH probe ranged between 0.2% and 0.96% and between 1.45% and 6.5% to the distal pH probe during the 3 measurements. Acid exposure was always lower to the proximal than to the distal probe (P =.001). Patients with neck anastomoses had increasing acid exposure to the distal (P =.023) and proximal (P =.002) pH probes during the study year, whereas patients with chest anastomoses had similar acid exposure.CONCLUSIONS: Acid exposure to the esophageal remnant and to the pharynx increased during the first postoperative year in patients with neck anastomoses but not in patients with proximal chest anastomoses. The results suggest a less favorable acid clearance in patients with the neck approach.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

Anastomosis, Surgical/adverse effects

Dissection/adverse effects

Esophagectomy/adverse effects

Esophagus/physiopathology

Evaluation Studies as Topic

Female

Follow-Up Studies

Gastric Acid/metabolism

Gastroesophageal Reflux/etiology

Humans

Hydrogen-Ion Concentration

Male

Monitoring, Ambulatory

Neck

Pharyngeal Diseases/etiology

Pharynx/physiopathology

Pneumonia, Aspiration/etiology

Surgical Stapling/methods

Suture Techniques

Thorax

Publikations- och innehållstyp

art (ämneskategori)

ref (ämneskategori)