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
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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.Diseases of the Esophagus 05/2013; · 1.64 Impact Factor
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