title: Laparotomy after using the gastroepiploic artery graft: retrogastric versus antegastric route.
abstract: BACKGROUND
  Most cardiac surgeons prefer the antegastric route for the right gastroepiploic artery (RGEA) graft. When placed anterior to the stomach, the RGEA pedicle may adhere to the greater omentum, or to the anterior abdominal wall, and may be injured during future abdominal operations.
  
  
  METHODS
  To avoid this potentially lethal complication, we prefer to place the RGEA graft behind the stomach and the left lobe of the liver. In our experience with 144 patients in whom the retrogastric route was used, 7 patients required an abdominal operation (2 had cholecystectomy, 2 had a partial colectomy, 1 had repair of paraesophageal hernia, and 2 had repair of abdominal wall complications). There was no need to dissect the RGEA graft in any of these patients.
  
  
  RESULTS
  There was no evidence of myocardial ischemia or other complications during or after the operation in any patient.
  
  
  CONCLUSIONS
  Based on our experience and the fact that any injury to the RGEA graft may have catastrophic consequences, we strongly advocate the retrogastric route to minimize the risk of injury to the RGEA graft during a subsequent laparotomy.
authors.affiliation: Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, PA 17822-1343, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Dietl
authors.forename: J E
authors.initials: JE
authors.lastname: Deitrick
authors.forename: J C
authors.initials: JC
authors.lastname: West
authors.forename: T J
authors.initials: TJ
authors.lastname: Pagana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D013270:Stomach / Q000098:blood supply*