Περίληψη:
Duodenogastric reflux (DGR) is a common sequel of subtotal esophagectomy
and gastric pull-up, and it may contribute to mucosal changes of both
the gastric conduit and the esophageal remnant. This study investigated
the effect of the route of reconstruction on the DGR. 24-hour ambulatory
bilirubin monitoring was performed on patients who underwent transhiatal
subtotal esophagectomy and a gastric tube interposition either in the
posterior mediastinum (PM group, n = 11), or in the retrosternal space
(RS group, n = 8): A Control group of 8 healthy volunteers was also
studied. The median percentage of reflux time, the median number of
reflux episodes, and the median number of reflux episodes longer than 5
minutes, in PM versus RS groups, were 29.1% versus 0.15% (p < 0.001),
185 versus 8 (p = 0.002) and 10 versus 0 (p = 0.001), respectively. The
values of the above variables in PM versus control groups were 29.1%
versus 3.95% (p = 0.007), 185 versus 21 (p = 0.02), and 10 versus 2 (p
= 0.009), respectively, whereas in RS versus control groups they were
0.15% versus 3.95% (p = 0.01), 8 versus 21 (p = 0.04), and 0 versus 2
(p = 0.05), respectively. Posterior mediastinal gastric interposition is
associated with high reflux of duodenal contents, whereas retrosternal
interposition minimizes the reflux at levels even lower than those of
the healthy individuals. The latter type of reconstruction may be a good
alternative from that perspective, especially in patients with long life
expectancy.
Συγγραφείς:
Katsoulis, IE
Robotis, I
Kouraklis, G
Yannopoulos, P
