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Background: Leakage of oesophagogastric anastomosis has been associated with poor perfusion of the gastric tube. The authors recently developed a new form of gastroplasty, preserving not only the arterial arcade along the greater curvature, but also the lesser curvature. In this study their first clinical experience with that gastric tube is reported., Methods: Thirty-five patients undergoing either oesophagectomy or laryngopharyngo-oesophagectomy for malignant lesions and substitution of the oesophagus with a funds rotation gastroplasty were included. Patient outcome, including anastomotic leak, hospital mortality and morbidity rates, were studied prospectively., Results: Hospital mortality rate was one of 35 and anastomotic leak (one minor, one moderate) was found in two patients with no subsequent mortality. Further major morbidity included pulmonary dysfunction in the form of acute respiratory distress syndrome (ARDS) in seven patients. Mean (s.e.m.) hospital stay was 27(19) days, and 21(9) days in patients who did not develop ARDS., Conclusion: Fundus rotation is a new method of gastroplasty that allows safe anastomosis of the tube with the remaining oesophagus or pharynx and is associated with a low leak rate even at high cervical levels.

Risk factors for recurrent laryngeal nerve (RLN) lesions after thyroid gland surgery were evaluated retrospectively in 1026 patients. RLN palsy occurred in 5.9 per cent; the incidence of permanent palsy was 2.4 per cent as 59 per cent of paralyses were transient. For euthyroid nodular goitre, Graves' disease, chronic lymphocytic thyroiditis, recurrent goitre and thyroid carcinoma, permanent nerve damage occurred in 1.7, 4, 5, 3.8 and 8 per cent of patients respectively. In relation to the number of nerves at risk, the incidence of permanent RLN palsy was 1.1 per cent for subtotal lobectomy and 4.0 per cent for total lobectomy. The overall incidence of permanent RLN palsy was 1.8 per cent of nerves at risk. There was no statistically significant difference between the number of RLN paralyses occurring after nerve exposure and that occurring after non-exposure in subtotal lobectomy, but in total lobectomy the permanent palsy rate increased from 3.8 to 7 per cent when the nerve was not exposed or identified (P < 0.01). Underlying thyroid disease, the extent of resection and exposure of the nerve in total lobectomy are risk factors for both transient and permanent RLN palsy.