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J Thorac Cardiovasc Surg 1999;118:1078-1083
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

PHARYNGEAL REFLUX AFTER GASTRIC PULL-UP ESOPHAGECTOMY WITH NECK AND CHEST ANASTOMOSES

From the Department of Surgery, Lund University, Lund, Sweden,^a and the Department of Preventive Medicine, University of Southern California, Los Angeles, Calif.^b

Address for reprints: Jan Johansson, MD, Department of Surgery, Lund University Hospital, S-221 85 Lund, Sweden (E-mail: Jan.Johansson{at}kir.lu.se ).

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.

This study was supported by grants from the Medical Faculty, Lund University, Lund, Sweden, the Crafoord Foundation, Lund, Sweden, and by grants from Gunnar, Arvid and Elisabeth Nilsson’s Foundation for Treatment of Malignant Disorders, Helsingborg, Sweden.

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