Three-dimensional pressure imaging: a novel method for intraoperative manometry during laparoscopic esophagomyotomy for esophageal achalasia

Jejunal pouch interposition with fundic-like plication after total gastrectomy

PURPOSE

We developed a technique of jejunal pouch interposition with a fundic-like jejunal plication (JPI-FP) for reconstruction after total gastrectomy (TG) for gastric cancer. The aim of this study was to investigate the advantages of JPI-FP over Roux-en-Y reconstruction (R-Y).

METHODS

Twenty-two patients who had undergone TG more than 1 year earlier were classified into two groups according to the method of reconstruction used: Group A (n = 7) underwent R-Y, and group B (n = 15) underwent JPI-FP. Group B was subdivided into two groups to examine the usefulness of additional pylorus preservation: group B1 (n = 8), pylorus (-) and group B2 (n = 7), pylorus (+).

RESULTS

Food intake and body weight were significantly higher in group B than in group A (P < 0.05). Reflux esophagitis was diagnosed in two of the group A patients, but in none of the group B patients. Excessive esophageal bile exposure, determined as the fraction time of esophageal bilirubin absorbance over 0.14 > 50%, was significantly higher in group A than in group B (P < 0.05). There was no significant difference in bile exposure in the jejunal pouch between groups B1 and B2.

CONCLUSIONS

JPI-FP is a superior method of reconstruction after TG to prevent excessive esophageal bile reflux and from a nutritional aspect. The advantage of pylorus preservation remains unconfirmed.

Esophageal motor disorders

Refinements continue in the measurement, display, and interpretation of pressure events that serve as signatures of esophageal motor disorders, and esophageal manometry retains its position as the diagnostic gold standard. The focus of attention remains with achalasia, not because of pathophysiologic developments or changing prevalence, but in response to the growing interest in minimally invasive surgery and its success. Some controversy remains regarding the role of preoperative motility assessments in patients undergoing antireflux surgery, as peristaltic features do not solely predict outcome. The disconnect between motor dysfunction and symptoms continues to promote careful consideration of sensory dysfunction as a component of esophageal motor disorders.