Merendino procedure vs. transhiatal resection: Which procedure offers better outcome and quality of life?

Eichelmann A, Nikitina M, Slepecka P, Senninger N, Palmes D.

Zusammenfassung

Background:A limited resection of the cardia with resection of the esophagogastric junction can either be performed by the Merendino procedure with reconstruction by an isoperistaltic jejunal interposition or by transhiatal resection of the distal esophagus with reconstruction by a stomach tube. The aim of the study was to compare postoperative complications and quality of life between both procedures.Materials and methods:Between 2011 and 2017, 22 patients with Merendino reconstruction and 17 patients with transhiatal resection were included in the retrospective analysis. Esophagojejunal anastomosis was performed in 17 patients with a stapler in the Merendino group (77,3%), while a stapler-based esophagogastric anastomosis was performed in 16 patients in the transhiatal group (94%). Occurrence of postoperative complications (according to Clavien-Dindo classification), length of stay and quality of life regarding gastrointestinal symptoms (dysphagia, reflux, pain, eating disorders) were compared and tested for significant differences between the study groups using Mann-Whitney-U test and Fisher Exact test (p<0.05).Results:In the transhiatal group, median age of the patients was significantly higher than in the Merendino group (71 years [53-92] vs. 57,5 years [19-75], p=0.0002). Moreover, postoperative length of stay was prolonged in the transhiatal group (35,9 +/- 28,1 days vs. 18,2 +/- 10,6 days, p=0.0002) and patients who underwent a transhiatal resection had a higher rate of anastomotic leakage (24% vs. 9%, p=0.0171). On the other hand, the complication rate according to Clavien-Dindo grade 1-5 was similar between both groups (p=0.1694). Regarding quality of life, 14% of the patients who underwent a reconstruction after Merendino suffered from dysphagia.Conclusion:Our study suggests that both the Merendino procedure and transhiatal resection for limited resection of the cardia are similar with regard to complication rates and functional outcome. Because of the fact that the Merendino procedure aims to substitute the lower oesophageal sphincter by isoperistaltic jejunal interposition, this procedure should be preferred especially in younger patients.