Abstract
The most critical component of esophagectomy is the preparation of the esophageal replacement conduit and completion of the esophagogastric anastomosis. The preserved vascular perfusion and the functional motility of the esophageal conduit are essential for a successful postoperative outcome and good quality of life for the patient. The typical esophageal replacement conduit options that are available for esophageal replacement include the stomach, colon, and jejunum. Postoperative conduit necrosis is a potentially life-threatening event; therefore, the recognition of the associated clinical signs and symptoms are crucial. The appropriate management of conduit necrosis includes debridement, resection of the esophageal conduit, esophageal diversion, and staged esophageal reconstruction. The stomach is the most commonly utilized esophageal replacement conduit in the current practice for patients undergoing esophagectomy.
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References
Heitmiller RF. Impact of gastric tube diameter on upper mediastinal anatomy after transhiatal esophagectomy. Dis Esophagus. 2000;13:288–92.
Thomas DM, Langford RM, Russell RCG, Le Quesne LP. The anatomic basis for gastric mobilization in total oesophagectomy. Br J Surg. 1979;66:230–3.
Libermann-Meffert DMI, Meier R, Siewart JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg. 1992;54:1110–5.
Pierie JP, deGraf PW, van Vroonhoven TJ, Obertop H. The vascularization of the gastric tube as a substitute for the esophagus. Dis Esophagus. 1998;11:231–5.
Lam TC, Fok M, Chang SW, Wong J. Anastomotic complications after esophagectomy for cancer. A comparison of neck and chest anastomoses. J Thorac Cardiovasc Surg. 1992;104:395–400.
Dewar L, Gelfand G, Finley RJ, Evans K, Inculet R, Nelems B. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg. 1992;163:484–9.
Mathisen DJ, Grillo HC, Wilkins EW Jr, Moncure AC, Hilgenberg AD. A safe approach to carcinoma of the esophagus. Ann Thorac Surg. 1988;45:137–43.
Heitmiller RF, Fischer A, Liddicoat JR. Cervical esophagogastric anastomosis: results following esophagectomy for carcinoma. Dis Esophagus. 2000;12:264–70.
Kassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013;96:1919–26.
Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refinements. Ann Surg. 1999;230:392–400.
Peracchia A, Bardini R, Ruol A, Asolati M, Scibetta D. Esophagovisceral anastomotic leak. A prospective study of predisposing factors. J Thorac Cardiovasc Surg. 1988;95:685–91.
Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg. 2003;138:303–8.
Shuchert MJ, Luketich JD, Fernando HC. Complications of minimally invasive esophagectomy. Semin Thorac Cardiovasc Surg. 2004;16:133–41.
Briel JW, Tamhankar AP, Hagen JA, Demeester SR, Johansson T, Choustoulakis E, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198:536–42.
Moorehead RJ, Wong J. Gangrene in esophageal substitutes after resection and bypass procedures for carcinoma of the esophagus. Hepatogastroenterology. 1990;37:364–7.
Blackmon SH, Correa AM, Skoracki R, Chevray PM, Kim MP, Mehran RJ, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10 year experience. Ann Thorac Surg. 2012;94:1104–13.
Urschel JD. Ischemic conditioning of the stomach may reduce the incidence of esophagogastric anastomotic leaks complicating esophagectomy: a hypothesis. Dis Esophagus. 1997;10:217–9.
Sekido M, Yamamto Y, Minakawa H, Saski S, Furukawa H, Sugihara T, et al. Use of “supercharge” technique in esophageal and pharyngeal reconstruction to augment microvascular blood flow. Surgery. 2003;134:420–4.
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Merritt, R. (2015). Intra-Operative Solutions for Ischemic Gastric Conduit. In: Pawlik, T., Maithel, S., Merchant, N. (eds) Gastrointestinal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2223-9_10
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DOI: https://doi.org/10.1007/978-1-4939-2223-9_10
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