A Laparoscopic Vagus Preserving Merendino Procedure

Laparoscopic vagal preserving oesophagectomy is a recognised treatment option for high grade dysplasia of the oesophagus[1]. A jejunal interposition, as described by Alvin Merendino in 1955[2], aims to substitute the lower oesophageal sphincter, thereby treating physiological disorders such as reflux oesophagitis.
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)[3].
Our edited video demonstrates a successful 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 inramucosal 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 69.8kg, 63.2kg and 62.7kg.
A laparoscopic vagal preserving Merendino procedure is technically feasible. It also offers a physiologically advantageous procedure for the patient.
1. DeMeester SR (2005) Endoscopic mucosal resection and vagal-sparing oesophagectomy for high grade dysplasia and adenocarcinoma of the oesophagus. Seminars in Thoracic and Cardiovascular Surgery 17: 320-325
2. Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejunal segment of anatomic and physiological abnormalities at the oesophagogastric junction. With special reference to reflux oesophagitis, cardiospasm and oesophageal varices. Annals of Surgery 142: 486-509
3. Borgaonkar R, Irvine EJ (2000) Quality of life measurement in gastrointestinal and liver disorders. Gut 47: 444-454

Session: Podium Presentation

Program Number: V024

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