Organ-preserving resection of the gastroesophageal junction and substitution with a gastric corpus rotation tube: An experimental study

Premalignant lesions of the gastroesophageal junction are treated conservat ively or by antireflux surgical procedures. We describe a novel technique t hat replaces the distal esophagus after resection of the gastroesophageal j unction. After resection of the gastroesophageal junction, 16 pigs were div ided into two groups. In group 1 (n = 9) the gastroesophageal junction was replaced with a 3 cm wide horizontal gastric corpus tube, pedicled at the l esser curvature. In group 2 (n = 7) the tube was pedicled at the greater cu rvature. Tube length, volume, and compliance of the gastric remnant and blo od flow in the tube (by laser Doppler flowmetry given in perfusion units [P U]) were measured before and after tube formation and 2 weeks postoperative ly. Group 1 tubes were 9.5 +/- 1.5 cm long and group 2 tubes were 8.2 +/- 0 .7 cm long. Tube formation decreased volume and compliance of the gastric r emnant. After tube formation, blood flow at the tip of the tube decreased f rom 254 PU to 64 +/- 22 PU (group 1) and 87 +/- 36 PU (group 2). Volume, co mpliance, and blood flow returned to baseline values 2 weeks postoperativel y. No anastomotic leakage was found on postmortem examination. Horizontal g astric corpus tubes might offer an alternative to replace the distal esopha gus and proximal stomach after resection of premalignant lesions of the gas troesophageal junction.