ESOPHAGEAL REPLACEMENT - GASTRIC TUBE OR WHOLE STOMACH

Background. The stomach can be used either in its entirety or as a gre ater curvature tube for esophageal replacement. Methods. The study com pares the gastric tube (group A; n = 112) to the whole stomach whose l esser curvature is denuded (group B; n = 100) in terms of technical co mplication and alimentary comfort. The clinical results are substantia ted by assessment of the eating performance of patients and control su bjects at a test meal, measurement of the gastric dimensions before an d after both tailoring procedures, and intraarterial staining of the g astric wall. Results. Major differences between the two groups are cer vical anastomosis stenoses (22.3% versus 6% [A versus B]; p = 0.008), fistulas (7.9% versus 1%; p = 0.0209), number of meals and snacks per day (4.6 versus 4; p = 0.0275), sensation of early fullness at meals ( 52.4% versus 17.8%; p < 0.0001), ratings given to the long-term alimen tary comfort (presymptomatic condition = 10 points) (7.6 versus 8.8 ou t of 10 on average; p < 0.0001), and calories consumed in 1 minute at a test meal (59% [p < 0.05] versus 77% of those consumed by control su bjects). The volume of the stomach is reduced by a range of 21.4% to 4 7.2% after tubulization (group A) whereas it increases by a range of 4 .9% to 17.4% after denudation of the lesser curve (group B). Intraarte rial staining of the gastric wall reveals the poor vascularity of the upper-most segment of the greater curve. Conclusion. Slight increase o f the gastric capacity and maintenance of the submucosal vascular netw ork account for the better results achieved with the whole stomach.