The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 679-685, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Intercostal pedicle method for control of postresection esophagitis. Thirteen-year clinical study
NJ Demos and RM Biele
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.
