title: Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube.
abstract: OBJECTIVE
  An extra-anatomic reconstruction would be beneficial in preventing recurrent malignant dysphagia. A long gastric tube that allowed a sufficient blood flow was necessary to perform the successful cervical anastomosis through the retrosternal route.
  
  
  METHODS
  The gastric tube was created by means of separate division and closure of the seromuscular and submucosal-mucosal layers (stepwise group) in 15 consecutive patients and by means of full-thickness cutting of the stomach and closure of the seromuscular layer (standard group) in 22 patients. We compared these 2 types of gastroplasties in terms of total length of the tube, blood flow, and the incidence of anastomotic leakage. Blood flow was measured with a laser Doppler flowmeter during surgical intervention.
  
  
  RESULTS
  The gastric tube in the stepwise group was significantly longer than that in the standard group (P <.01, unpaired t test). Tissue blood flow at the site of anastomosis in the stepwise group was significantly greater than that in the standard group (P <.01, unpaired t test), and the rate of anastomotic leakage in the stepwise group was significantly lower than that in the standard group (P <.05, chi(2) test).
  
  
  CONCLUSIONS
  We consider this technique to be a useful procedure for retrosternal reconstruction after subtotal esophagectomy.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. yikeda@med.teikyo-u.ac.jp
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Shoichi
authors.initials: S
authors.lastname: Tobari
authors.forename: Masanori
authors.initials: M
authors.lastname: Niimi
authors.forename: Shigenao
authors.initials: S
authors.lastname: Kan
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takami
authors.forename: Susumu
authors.initials: S
authors.lastname: Kodaira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D013270:Stomach / Q000098:blood supply / Q000601:surgery*