Control of postresection gastroesophageal reflux: the intercostal pedicle esophagogastropexy experience of 26 years

Abstract

The devastating consequences of reflux subsequent to transthoracic esophagogastrostomy are aspiration, regurgitation, bleeding, recurrent pneumonias, and recurrent strictures in the majority of patients. The misery of eight such patients was personally witnessed. None of them could sleep in their bed at night. Sixty-eight patients were protected from reflux by the intercostal pedicle esophagogastropexy in the last 26 years. They were followed for 1500 months with esophagram, endoscopy, motility, and pH studies. None had disabling reflux or its complications. Eight patients died. Two patients who survived 18 and 10 years have controllable dumping. The histology of the pedicle was preserved without causing any morbidity. A most gratifying group of five patients with benign disease were protected by the pedicle and survived so far from 2 to 23 years. The intercostal pedicle esophagogastropexy is the only antireflux procedure which has consistently prevented reflux through intrathoracic anastomosis over the past 26 years and 1500-month patient follow-up.