Abstract
Introduction
Laparoscopic vagal preserving oesophagectomy is a recognised treatment option for high-grade dysplasia of the oesophagus. A jejunal interposition, as described by Alvin Merendino in 1955, aims to substitute the lower oesophageal sphincter, thereby treating physiological disorders such as reflux oesophagitis.
Methods
We aimed to combine these procedures in the treatment of an otherwise healthy patient, who presented with high-grade dysplasia on surveillance endoscopy, with particular reference to technical feasibility and to Quality of Life as assessed by the Gastrointestinal Quality of Life Index (GIQLI).
Results
We performed a laparoscopic vagus preserving Merendino procedure with sentinel lymph node biopsy. The patient made an entirely uncomplicated recovery and was discharged on day 7. His pathological specimen reported intramucosal carcinoma and high-grade dysplasia within Barrett’s oesophagus. 0/4 lymph nodes were involved. His GIQLI scores preoperatively, at 2 and 4 weeks postoperatively, were 111, 98 and 105, respectively. His weight at the corresponding times was 69.8, 63.2 and 62.7 kg.
Conclusion
A laparoscopic vagal preserving Merendino procedure is technically feasible. It also offers a physiologically advantageous procedure for the patient.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
British Society of Gastroenterology. Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. A report of the working party of the British Society of Gastroenterology www.bsg.org.uk
Dehn T, Barr H, Maynard N (2006) Controversial topics in surgery: high grade dysplasia in Barrett’s oesophagus. Ann R Coll Surg Engl 89:586–590
Butter NS, Wang KK, Lutzke LS (2001) Combined endoscopic mucosal resection and photodynamic therapy for oesophageal neoplasia within Barrett’s oesophagus. Gastrointest Endosc 54:682–688
Montgomery E, Goldblum JR, Greenson JK, Haber MM, Lamps LW, Lauwers GY, Lazenby AJ, Lewin DN, Robert ME, Washington K, Zahurak ML, Hart J (2001) Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study. Hum Pathol 32:379–388
Schnell TG, Sontag SJ, Chejifec G, Aranha G, Metz AD, Connell S, Seidel UJ, Sonnenberg A (2001) Long-term non-surgical management of Barrett’s esophagus with high grade dysplasia. Gastroenterology 120:1607–1619
Birkmeyer JD, Siewers MPH, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137
Nruyen NT, Schauer P, Luketich JD (2000) Minimally invasive esophagectomy for Barrett’s esophagus with high grade dysplasia. Surgery 127:284–290
DeMeester SR (2005) Endoscopic mucosal resection and vagal sparing esophagectomy for high-grade dysplasia and adenocarcinoma of the esophagus. Thorac Cardiovasc Surg 17:320–325
Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 12:733–742
Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Thiesen J, Peters JH, Kiyabu M (1999) Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. Ann Surg 230:433–440
Lamb PJ, Griffin SM, Burt AD, Lloyd J, Karat D, Hayes N (2005) Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma. Br J Surg 92:60–67
Eypasch EP, Williams JI, Wood-Dauphinee S (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82:216–222
Stein HJ, Feith M, Bruecher B, Naehrig J, Sarbia M, Siewert JR (2005) Early esophageal cancer. Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 242:566–573
Krishnadath KK, Wang KK, Taniguchi K, Sebo J, Buttar NS, Anderson MA, Lutzke LS, Liu W (2000) Persistent genetic abnormalities in Barrett’s esophagus after photodynamic therapy. Gastroenterology 119:624–630
Van Laethem JL, Peny MO, Salmon I, Cremer M, Deviere J (2000) Intramucosal adenocarcinoma arising under squamous reepithelialisation of Barrett’s esophagus. Gut 46:574–577
Gondrie JJ, Pouw RE, Sondermeijer CM, Peters FP, Curvers WL, Rosmolen WD, Ten Kate F, Fockens P, Bergman JJ (2008) Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system. Endoscopy 40:370–390
Pech O, May A, Rabenstein T, Ell C (2007) Endoscopic resection of early esophageal cancer. Gut 56:1625–1634
Blazeby JM, Farndon JR, Donovan J, Alderson D (2000) A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 88:1781–1787
Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiological abnormalities at the esophagogastric junction. Ann Surg 142:486–506
Stein HJ, Hutter J, Feith M, von Rahden BHA (2007) Limited surgical resection and jejunal interposition for early adenocarcinoma of the distal esophagus. Thorac Cardiovasc Surg 19:72–78
Disclosures
Mr. C. M. Pring and Mr. S. P. L. Dexter have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MPG 195170 kb)
Rights and permissions
About this article
Cite this article
Pring, C., Dexter, S. A laparoscopic vagus-preserving Merendino procedure for early esophageal adenocarcinoma. Surg Endosc 24, 1195–1199 (2010). https://doi.org/10.1007/s00464-009-0736-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0736-4