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November 29, 1958


Author Affiliations


From the Department of Surgery, University of Washington School of Medicine.

JAMA. 1958;168(13):1759-1766. doi:10.1001/jama.1958.03000130025007

It is now possible to excise the esophagogastric junction for such conditions as reflux esophagitis with stricture with restoration of continuity and without fear of recurrent esophagitis. The operation here described involves the interposition of a segment of jejunum, from 15 to 48 cm. in length, with certain precautions taken to make sure of a good blood supply. Four anastomoses have to be made, the most crucial being that between the esophagus and the jejunal segment. In a period of six years this interposition operation has been carried out in 33 patients. Four postoperative deaths occurred, and analysis of the case histories indicates that improvements in technique would reduce the mortality significantly. Among the other 29 patients there has been no dysphagia, and the functioning of the interposed segment of jejunum has been studied by roentgen ray in patients up to six years after operation. All patients, including some with cardiospasm, esophageal varices, and lye stricture, were relieved to be able to swallow normally again, and the majority ate three meals a day, but 6 established a pattern of eating five or six times a day, and 12 were apparently unable to vomit. The substitution of a segment of jejunum for the esophagogastric sphincter is a sound physiological procedure.