Gastroesophageal physiology after stapled gastroesophagostomy in dogs.
A stapled vertical gastroesophagostomy (VGE) has been proposed for benign esophageal stricture. The VGE involves performing an anastomosis using a linear cutting stapler inserted via a gastrotomy (one limb in the esophagus, the other in the proximal fundus). In phase I of the study, a 50-mm VGE was performed in 13 dogs; 7 received an additional fundoplication. Endoscopy with pinch biopsies, esophageal manometry, and 4-hour ambulatory pH recordings were performed in each dog prior to and 1 month after VGE. The only difference between groups postoperatively was a higher lower esophageal sphincter pressure in the group with the added fundoplication. The incidence of histologic esophagitis was low in both groups. In phase II of the study, a VGE was performed in six dogs using a 75-mm linear cutting stapler, accompanied by fundoplication in each dog. These dogs were then followed for 6 months to more completely assess the long-term risk of developing reflux esophagitis. At necropsy, no gross or histologic evidence of esophagitis was found. The performance of a VGE through the lower esophageal sphincter in normal dogs does not result in significant reflux esophagitis. VGE may be an alternative to resection for esophageal stricture.
Edwards
M
M
Department of Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230.
Mortenson
D
D
Vasudeva
R
R
Holt
S
S
Folse
J R
JR
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D004285:Dogs; D004940:Esophageal Stenosis / Q000503:physiopathology / Q000601:surgery*; D004941:Esophagitis / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology / Q000503:physiopathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005745:Gastric Acidity Determination; D011312:Pressure; D013270:Stomach / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013528:Surgical Staplers; D014945:Wound Healing