Reducing the gastroesophageal reflux with lip-type reinforcement technique during intrathoracic esophagogastrostomy.

Background/aims: Gastroesophageal reflux is a significant problem after esophagogastrostomy, and impact considerably upon the quality of patients' lives. Aims of this study were to evaluate the operative effects in prevention of reflux with lip-type reinforcement during intrathoracic esophagogastric anastomosis.

Methodology: From January 2005 to December 2009, 216 patients received circular stapled esophagogastrostomy with lip-type reinforcement (LR group), and 69 patients with standard reinforcement (SR group) at our hospital. Major observation parameters were symptoms of reflux and dysphagia.

Results: No differences in clinicopathologic characteristics between two groups, in addition to the incidence of anastomotic leakage was less in LR group (p = 0.039). Grade of dysphagia and anastomotic stricture also were not different between two groups (p >0.05). Symptoms of reflux were better controlled in patients with lip-type reinforcement than standard reinforcement (p <0.001). In LR group, 71.3% were asymptomatic with respect to reflux compared to 29.7% in SR group (p <0.001). The incidence of reflux esophagitis was 23.5% in LR group and 58.3% in SR group (p <0.001). There was a significant correlation between reflux symptoms and endoscopic findings of reflux esophagitis (p = 0.001).

Conclusions: Lip-type reinforcement is simple to perform, and effective in controlling gastroesophageal reflux and decreasing anastomotic leakage in majority of patients after esophagogastrostomy.