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A modified end-to-side esophagogastrostomy devised at our department to prevent postoperative reflux was evaluated both experimentally in 15 dogs and clinically in 4 cases. The seromuscular coat of the anterior wall of the remnant stomach was excised longitudinally, the distal esophagus was buried and anastomosed at its distal end so as to provide an effective thin flap valve. The presence of gastroesophageal reflux was attested by the use of withdrawal pH, intraluminal pressure and fluoroscopy studies as well as by autopsy in dogs. Furthermore, 7 out of 15 dogs were subjected to the analytical study of reflux prevention mechanism employing an intraoperative pressure measurement. The results are summarized as follows: Gastroesophageal reflux was absent in 11 out of 15 dogs and in all the 4 clinical cases. A specific finding after this procedure was that even after resection of the cardia, there was seen creation of an artificial high pressure zone at the site of the anastomosis serving as a barrier to reflux. Reflux prevention mechanism of the present method lies in an effective flap valve mechanism which seals the distal esophagus receiving the side pressure from the artificial fundus. The procedure is technically easy and seems to serve overcoming the problem of postoperative reflux highly seen after conventional end-to-end or end-to-side esophagogastrostomy.

EXPERIMENTAL AND CLINICAL STUDIES ON ANTI-REFLUX EFFECT OF MODIFIED END-TO-SIDE ESOPHAGOGASTROSTOMY IN PROXIMAL GASTRECTOMY