ABSTRACT
In attempting to solve the problem of gastroesophageal reflux esophagitis, we tested an experimental technique in 1967. In the past 13 years we have applied that intercostal pedicle method to prevent reflux in 43 patients. Thirty-four patients had esophagogastrectomy and esophagogastrostomy for cancer. Six additional patients underwent palliative, nonresective esophagogastrostomy. In another two patients the lower esophagus was resected for complete full-wall thickness fibrous stricture. One patient had severely symptomatic reflux. Six patients treated by resection for cancer are long-term survivors. The two patients with benign stricture were followed for 2 years and the last patient with severe reflux symptoms was followed for 13 years. History, esophagography, fluoroscopy, and fiberoptic esophagoscopy were used for follow-up in 40 of 43 patients. Motility and pH studies were used for follow-up in 21 instances. There have been no symptoms of regurgitation and reflux. No stricture has been seen though one patient needed a few dilatations for the first 2 years and none in the last 2 years. The esophagogram shows a typical slinglike appearance. The lower esophageal sphincter-like pressure has been as high as 26 mm Hg in the immediate postoperative period, settling to 12 to 15 mm Hg in the long-term follow-up. The pH is definitely alkaline in the esophagus. Competence has also been observed in the only two patients who had an ephemeral anastomotic leak. We recommend the intercostal pedicle technique in all cases of esophagogastrostomy performed in the chest.
