Abstracts
1999 Digestive Disease Week

# 2117 FUNCTIONAL RESULTS OF VAGAL-PRESERVING ESOPHAGEAL RESECTION WITH JEJUNAL INTERPOSITION
J Salo, Helsinki Univ Ctral Hosp, Helsinki Finland; J Salminen, O J Ramo, P Nikkinen, M Farkkila, J Isolauri

Vagal denervation in connection with esophageal resection causes often dumping, diarrhea, and gastritis. Nevertheless, there are only few functional studies concerning vagal-preserving esophageal resections (VPER). VPER with jejunal interposition was performed in 16 patients (P), with no mortality, (10 men, 6 females, mean 58 y, range 25-74) between 1994-98. Indications: 11 esophageal stricture and/or dysplasia caused by reflux, 3 achalasia, 1 epiphrenic diverticulum, 1 leiomyoma. 7 P (44%) had had 1-2 previous operations. 3 P (19%) had postoperative complications: stroke, mediastinal haematoma and gynecologic candida-sepsis. None had reflux symptoms, dumping or diarrhea. Slight dysphagia was present in 1 P (6%). All 16 P had normal postoperative endoscopy and barium swallow. 10 P > 1 year postoperatively had pH-measurement, radionuclide transit (Tc 99m-tin colloid in 10 ml water) and scintigraphic measurement of duodeno-gastro-jejunal reflux (Tc 99m labeled imidoacetic derivate) and were compared with 10 asymptomatic volunteers and 30 P having routine resection with colon interposition and vagotomy (15 with pyloroplasty, 15 with pyloric dilatation) as showed in Table. VPER with jejunal interposition: normal pH-measurement in all P, scintigraphic duodenogastric reflux 1 P, duodeno-gastro-jejunal reflux: 0 P. Colon interposition: duodenogastric reflux after pyloroplasty in 12 P (80%) after pyloric dilatation in 10 P (67%), duodenogastrocolic reflux after pyloroplasty in 6 P (40%) after pyloric dilation in 5 P (33%). Conclusion: The emptying of the jejunal interponate is significantly (<0.01) better than that of colonic. Duodeno-gastric and duodeno-gastro-jenunal reflux are significantly more uncommon (p<0.05) than after routine esophageal resection. VPER's indications are patients physically fit for distal esophageal resection in benign and dysplastic cases.

Time in seconds (SD) for
	VPER	Colon interposition	Control
90% stomach filling	37 ± 17	264 ± 219	9 ± 7
Emptying for 50%	13 ± 10	436 ± 320	7 ± 5
Mean transit	31 ± 17	305 ± 164	6 ± 2

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