FIRST CLINICAL-EXPERIENCE WITH FUNDUS ROTATION GASTROPLASTY AS A SUBSTITUTE FOR THE ESOPHAGUS

Background Leakage of oesophagogastric anastomosis has been associated with poor perfusion of the gastric tube. The authors recently develop ed a new form of gastroplasty, preserving not only the arterial arcade along the greater curvature, but also the lesser curvature. In this s tudy their first clinical experience with that gastric tube is reporte d. Methods Thirty-five patients undergoing either oesophagectomy or la ryngopharyngo-oesophagectomy for malignant lesions and substitution of the oesophagus with a fundus rotation gastroplasty were included. Pat ient outcome, including anastomotic leak, hospital mortality and morbi dity rates, were studied prospectively. Results Hospital mortality rat e was one of 35 and anastomotic leak (one minor, one moderate) was fou nd in two patients with no subsequent mortality. Further major morbidi ty included pulmonary dysfunction in the form of acute respiratory dis tress syndrome (ARDS) in seven patients. Mean(s.e.m) hospital stay was 27(19) days, and 21(9) days in patients who did not develop ARDS. Con clusion Fundus rotation is a new method of gastroplasty that allows sa fe anastomosis of the tube with the remaining oesophagus or pharynx an d is associated with a low leak rate even at high cervical levels.