The Split-Stomach Fundoplication After Esophagogastrectomy

Two complications associated with esophagogastrectomy are anastomotic leak and gastroesophageal reflux. We describe here a modification of an intrathoracic esophagogastrostomy using the gastric fundus to address these issues. After completion of the esophagogastrectomy, the fundus is divided to produce “wings.” After the esophagogastrostomy is performed, the wings are used to form a wrap around the anastomosis. This wrap is secured to the esophagus and to the stomach. All patients undergoing the split-stomach fundoplication were compared with all patients undergoing standard esophagogastrectomies. End points were in-hospital mortality, anastomotic leak, and postoperative endoscopic dilation. All living patients were contacted and questioned about refluxlike symptoms and completed the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) symptom severity questionnaire. Twenty-six patients underwent the split-stomach fundoplication (wrap group), compared to 54 patients undergoing standard resection (no wrap group). Occurrence of end points in the wrap vs. no wrap groups were, respectively, in-hospital mortality, 3.8% vs. 7.4% (P = NS); anastomotic leak, 0% vs. 17% (P = 0.03); reflux symptoms 20% vs. 60% (P < 0.001); postoperative dilation, 40% vs. 30% (P = NS). The median total GERD-HRQL score was 5 for the wrap group vs. 14 for the no wrap group (P = 0.03). The addition of the split-stomach fundoplication to esophagogastrectomy may decrease the incidence of anastomotic leak and postoperative refluxlike symptoms.