A laparoscopic vagus-preserving Merendino procedure for early esophageal adenocarcinoma

Abstract

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. 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). 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. A laparoscopic vagal preserving Merendino procedure is technically feasible. It also offers a physiologically advantageous procedure for the patient.