Article

Pedunculated gastric conduit interposition with duodenal transection after salvage esophagectomy: an option for increasing the flexibility of the gastric conduit.

Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Japan.
Journal of the American College of Surgeons (Impact Factor: 4.5). 03/2012; 214(5):e31-3. DOI: 10.1016/j.jamcollsurg.2012.01.048
Source: PubMed
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    ABSTRACT: Reconstruction following pharyngolaryngectomy with total esophagectomy is a challenging surgery to perform. Between April 2008 and August 2012, three types of modified gastric pull-up reconstruction procedures, including a gastric tube creation combined with a free jejunal transfer (n = 7), elongated gastric tube creation with vascular anastomoses (n = 2) and pedunculated gastric tube creation with Roux-en-Y anastomosis (n = 5), were performed after pharyngolaryngectomy with total esophagectomy. To clarify feasibility of these reconstructive methods, we retrospectively analyzed the short-term outcomes. There were no graft failures. Salivary fistulae were observed in two cases after high pharyngoenteral anastomoses due to oropharyngeal extension of hypopharyngeal cancers. Overall morbidity rate was 21.4%, and no deaths occurred. Although the operation time was shortest for pedunculated gastric tube reconstructions, morbidity rates were similar among all methods. All three types of modified gastric pull-up reconstruction procedures can be performed safely. We can choose one of these methods according to the tumor status and the patient condition, understanding advantages and disadvantages of each procedure.
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