Further update 10 months after a merendino interposition operation.

[medway]

In previous posts I explained the use of a section of jejunum being put between my remaining stomach and oesophagus. It is a major op and you have to be fit and well to undergo it.

10 months on and I seeing major improvements in my digestion. When i started eating after the op i had severe wind pains and feeling ill sometimes. These pain attacks have gone and the periods of feeling ill after eating have nearly gone. After some meals I just feel a bit 'yuk' and it passes fairly quickly. I find that if i eat too quickly I have to stop and wait for the jejunum to open up, let the wind out and then the food goes into my remaining stomach. The jejunum naturally squeezes the food down and seems to close up after. Its also a spiral coil in position I believe so its difficult for food to reflux.

A comment that perhaps other sufferers should be asking their surgeons. I had a section of jejunum added. This is a soft, twisty, flattened tube from lower down. As it is normally like a flattened tube, I get no reflux - none at all. So, if somebody is having a 'pull up' after a section is removed, why not a section of jejunum in between to stop reflux? I suspect the answer is that the operation is major as you need to go lower into the abdomen as well to take the jejunum out. Perhaps not everybody is fit enough to undergo it. I only had T1b. But its worth asking your surgeon if its an option to stop the reflux. Its certainly not a keyhole job. I have an abdominal scar from one side to the other.

The merendino operation was originally done many years ago for reflux only and is now being used sometimes for cancer.

[Hidden]

Thanks for the update and we are delighted that you are making good progress. It is an unusual form of surgery, apparently, but it is good that it has worked for you. I think surgeons tend to do operations on the basis of making things as simple as possible, avoiding 'unnecessary' complications, and one can understand the logic of that approach.

Have you been out on the boat?

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I thought that I would ask an Upper GI surgeon about this surgery, and this is what he has replied, obviously in general terms rather than about any individual like yourself. Neither is it a prediction of complications in any individual case, but it does give an insight into why the operation is unusual in the UK:

"This operation is [normally] for individuals with cancer at the top of the stomach in whom the top half is removed. If the stomach is joined to the oesophagus below the diaphragm then very bad reflux is the result. The interposition of jejunum stops this. The problem is more joins; and it can be difficult to get [the] jejunum higher than the diaphragm due to its blood supply. A simpler operation is to join stomach to oesophagus in the chest to avoid reflux or do a total gastrectomy. It is very unpopular in the UK as [it is] generally associated with more complications and poor proximal clearance."

[medway]

Interesting comments Alan. At previous meetings with my surgeon I have been more interested in survival and digestive problems but next time i see him in November, being an engineer, I'll ask him more about the technical issues. The complexity of the op explains the big scar I have. Because of all the joins he needed good access I suppose and also to sort out the passage through diaphragm. I know he took 5cm of oesophagus out, so maybe he was able to make the top join from below the diaphragm by reaching up.

As I have mentioned previously, you have to be fit to undergo this complex surgery. I was informed I was in the operating room 5 hours and it was the most complex operation done at maidstone hospital. They didn't tell me this bit before the op. My surgeon said he had done 5 or 6 of these ops so I wasn't a guinea pig.

I certainly got my monies worth from the NHS!

Dont forget fitness is important before operations at any age.

I did contact the OPA some time ago and said I would be pleased to discuss the op with anybody considering it, being careful to only discuss the after effects. The technical stuff is for the surgeon.