First clinical experience with fundus rotation gastroplasty as a substitute for the oesophagus

Background - Leakage of oesophagogastric anastomosis has been associated with poor perfusion of the gastric tube. The authors recently developed a new form of gastroplasty, preserving not only the arterial arcade along the greater curvature, but also the lesser curvature. In this study their first clinical experience with that gastric tube is reported. Methods - Thirty-five patients undergoing either oesophagectomy or laryngopharyngo-oesophagectomy for malignant lesions and substitution of the oesophagus with a fundus rotation gastroplasty were included. Patient outcome, including anastomotic leak, hospital mortality and morbidity rates, were studied prospectively. Results - Hospital mortality rate was one of 35 and anastomotic leak (one minor, one moderate) was found in two patients with no subsequent mortality. Further major morbidity included pulmonary dysfunction in the form of acute respiratory distress syndrome (ARDS) in seven patients. Mean (s.e.m.) hospital stay was 27(19) days, and 21(9) days in patients who did not develop ARDS. Conclusion - Fundus rotation is a new method of gastroplasty that allows safe anastomosis of the tube with the remaining oesophagus or pharynx and is associated with a low leak rate even at high cervical levels.