An antireflux anastomosis following esophagectomy: a randomized controlled trial.
BACKGROUND
Reflux of duodeno-gastric fluid is a significant problem after esophagectomy with gastric conduit reconstruction. Symptoms may be severe and impact considerably upon the quality of life. Previous studies have suggested that a fundoplication type anastomosis may limit post-esophagectomy reflux.


OBJECTIVE
The purpose of this study was to determine whether a modified fundoplication at the gastro-esophageal anastomosis prevents reflux after esophagectomy.


METHODS
Prospective multicenter randomized controlled trial to compare a conventional end of esophagus to side of gastric conduit anastomosis with a modified fundoplication anastomosis in patients undergoing esophagectomy with intrathoracic anastomosis. Major outcomes were reflux symptoms, symptoms of dysphagia, and complications.


RESULTS
Fifty-six patients were enrolled. The fundoplication anastomosis was associated with significantly lower incidence of reflux (40% vs 70%), as well as a reduced incidence of severe reflux (8% vs 30%). Disturbance of sleep due to reflux was significantly reduced in the fundoplication group (18% vs 47%) as was the incidence of respiratory symptoms. The fundoplication anastomosis was not associated with an increase in dysphagia, and there was no difference in complications between the two groups.


CONCLUSIONS
Fundoplication anastomosis during esophagectomy is effective in protecting patients from reflux symptoms after esophagectomy and improves quality of life, particularly with regard to sleep disturbance.
Aly
Ahmad
A
Austin Hospital, Melbourne, Australia.
Jamieson
Glyn G
GG
Watson
David I
DI
Devitt
Peter G
PG
Ackroyd
Roger
R
Stoddard
Chris J
CJ
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome