Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses
(1999) In The Journal of thoracic and cardiovascular surgery 118(6). p.83-1078- Abstract
OBJECTIVE: Pharyngeal reflux after a gastric pull-up esophagectomy may cause aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric pull-up esophagectomy and evaluates the impact of additional dissection of the esophagus that is necessary for neck anastomoses versus no neck exploration and proximal chest anastomoses.
METHODS: Forty-seven patients had circular stapled anastomoses in the apex of the right chest (n = 27 patients) or manually sutured neck anastomoses (n = 20 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent time pH less than 4 was registered 3, 6, and 12 months after the... (More)
OBJECTIVE: Pharyngeal reflux after a gastric pull-up esophagectomy may cause aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric pull-up esophagectomy and evaluates the impact of additional dissection of the esophagus that is necessary for neck anastomoses versus no neck exploration and proximal chest anastomoses.
METHODS: Forty-seven patients had circular stapled anastomoses in the apex of the right chest (n = 27 patients) or manually sutured neck anastomoses (n = 20 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent time pH less than 4 was registered 3, 6, and 12 months after the operation.
RESULTS: Mean acid exposure to the proximal pH probe ranged between 0.2% and 0.96% and between 1.45% and 6.5% to the distal pH probe during the 3 measurements. Acid exposure was always lower to the proximal than to the distal probe (P =.001). Patients with neck anastomoses had increasing acid exposure to the distal (P =.023) and proximal (P =.002) pH probes during the study year, whereas patients with chest anastomoses had similar acid exposure.
CONCLUSIONS: Acid exposure to the esophageal remnant and to the pharynx increased during the first postoperative year in patients with neck anastomoses but not in patients with proximal chest anastomoses. The results suggest a less favorable acid clearance in patients with the neck approach.
(Less)
- author
- Johansson, Jan LU ; Johnsson, Folke LU ; Groshen, S and Walther, B LU
- organization
- publishing date
- 1999-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anastomosis, Surgical/adverse effects, Dissection/adverse effects, Esophagectomy/adverse effects, Esophagus/physiopathology, Evaluation Studies as Topic, Female, Follow-Up Studies, Gastric Acid/metabolism, Gastroesophageal Reflux/etiology, Humans, Hydrogen-Ion Concentration, Male, Monitoring, Ambulatory, Neck, Pharyngeal Diseases/etiology, Pharynx/physiopathology, Pneumonia, Aspiration/etiology, Surgical Stapling/methods, Suture Techniques, Thorax
- in
- The Journal of thoracic and cardiovascular surgery
- volume
- 118
- issue
- 6
- pages
- 6 pages
- publisher
- Mosby-Elsevier
- external identifiers
-
- pmid:10595981
- scopus:0032742389
- ISSN
- 0022-5223
- DOI
- 10.1016/S0022-5223(99)70104-2
- language
- English
- LU publication?
- yes
- id
- 88763372-9e17-4c57-9794-81afd3433bd1
- date added to LUP
- 2019-05-26 19:03:42
- date last changed
- 2024-01-01 07:44:16
@article{88763372-9e17-4c57-9794-81afd3433bd1,
abstract = {{<p>OBJECTIVE: Pharyngeal reflux after a gastric pull-up esophagectomy may cause aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric pull-up esophagectomy and evaluates the impact of additional dissection of the esophagus that is necessary for neck anastomoses versus no neck exploration and proximal chest anastomoses.</p><p>METHODS: Forty-seven patients had circular stapled anastomoses in the apex of the right chest (n = 27 patients) or manually sutured neck anastomoses (n = 20 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent time pH less than 4 was registered 3, 6, and 12 months after the operation.</p><p>RESULTS: Mean acid exposure to the proximal pH probe ranged between 0.2% and 0.96% and between 1.45% and 6.5% to the distal pH probe during the 3 measurements. Acid exposure was always lower to the proximal than to the distal probe (P =.001). Patients with neck anastomoses had increasing acid exposure to the distal (P =.023) and proximal (P =.002) pH probes during the study year, whereas patients with chest anastomoses had similar acid exposure.</p><p>CONCLUSIONS: Acid exposure to the esophageal remnant and to the pharynx increased during the first postoperative year in patients with neck anastomoses but not in patients with proximal chest anastomoses. The results suggest a less favorable acid clearance in patients with the neck approach.</p>}},
author = {{Johansson, Jan and Johnsson, Folke and Groshen, S and Walther, B}},
issn = {{0022-5223}},
keywords = {{Anastomosis, Surgical/adverse effects; Dissection/adverse effects; Esophagectomy/adverse effects; Esophagus/physiopathology; Evaluation Studies as Topic; Female; Follow-Up Studies; Gastric Acid/metabolism; Gastroesophageal Reflux/etiology; Humans; Hydrogen-Ion Concentration; Male; Monitoring, Ambulatory; Neck; Pharyngeal Diseases/etiology; Pharynx/physiopathology; Pneumonia, Aspiration/etiology; Surgical Stapling/methods; Suture Techniques; Thorax}},
language = {{eng}},
number = {{6}},
pages = {{83--1078}},
publisher = {{Mosby-Elsevier}},
series = {{The Journal of thoracic and cardiovascular surgery}},
title = {{Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses}},
url = {{http://dx.doi.org/10.1016/S0022-5223(99)70104-2}},
doi = {{10.1016/S0022-5223(99)70104-2}},
volume = {{118}},
year = {{1999}},
}