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Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4352–4352 | Cite as

Reconstruction Using a Pedunculated Gastric Tube with Duodenal Transection After Esophagectomy and Pharyngolaryngectomy

  • Naoya Yoshida
  • Yoshifumi Baba
  • Eri Oda
  • Keisuke Kosumi
  • Takatsugu Ishimoto
  • Masayuki Watanabe
  • Yukiharu Hiyoshi
  • Shiro Iwagami
  • Junji Kurashige
  • Yasuo Sakamoto
  • Yuji Miyamoto
  • Hidetaka Sugihara
  • Kojiro Eto
  • Kazuto Harada
  • Hideo Baba
Gastrointestinal Oncology

Abstract

Background

Gastric conduit ischemia is sometimes correlated with anastomosis-related morbidities after esophagectomy and pharyngolaryngectomy.1 5 A lack of connection between the right and left gastroepiploic vessels and intraoperative injury to these vessels could cause conduit ischemia. In addition, tensioned anastomosis due to a short gastric tube also could contribute to anastomotic leaks. This report introduces a reconstruction technique using a pedunculated gastric tube with duodenal transection for these cases.

Methods

Creation of a gastric tube in the greater curvature of the stomach is performed with linear staplers. Only the right gastroepiploic vessels are preserved. The gastric tube is finally fashioned with a width of approximately 4 cm. The peripheral right gastroepiploic vessels to the pylorus are sacrificed. After the bulbs are transected, a pedunculated gastric tube is moved, with confirmation whether it has sufficient length for anastomosis in the neck. After the anal side of the gastric tube is transected, Roux-en-Y gastrointestinal anastomosis is performed. Finally, esophagogastric or pharyngogastric anastomosis is performed.

Results

Between November 2011 and September 2014, 18 patients underwent the reported reconstruction technique due to short gastric tubes in 10 patients and a lack of connection between the right and left gastroepiploic vessels in 8 patients. Anastomotic leaks occurred in three patients (16.7 %), conduit necrosis in no patients, and strictures in no patients, respectively. Two patients had an anastomotic grade 2 leak, and one patient had an anastomotic grade 3 leak.

Conclusion

The current reconstruction technique is a good alternative for patients at risk of conduit ischemia and patients with a short gastric tube after esophagectomy and pharyngolaryngectomy.

Keywords

Anastomotic Leak Reconstruction Technique Gastric Tube Indocyanine Green Linear Stapler 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (MP4 15935 kb)

References

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Naoya Yoshida
    • 1
  • Yoshifumi Baba
    • 1
  • Eri Oda
    • 1
  • Keisuke Kosumi
    • 1
  • Takatsugu Ishimoto
    • 1
  • Masayuki Watanabe
    • 2
  • Yukiharu Hiyoshi
    • 1
  • Shiro Iwagami
    • 1
  • Junji Kurashige
    • 1
  • Yasuo Sakamoto
    • 1
  • Yuji Miyamoto
    • 1
  • Hidetaka Sugihara
    • 1
  • Kojiro Eto
    • 1
  • Kazuto Harada
    • 1
  • Hideo Baba
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityChuokuJapan
  2. 2.Department of Gastroenterological SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchKoto-kuJapan

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