Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube.
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.
Ikeda
Yoshifumi
Y
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. yikeda@med.teikyo-u.ac.jp
Tobari
Shoichi
S
Niimi
Masanori
M
Kan
Shigenao
S
Takami
Hiroshi
H
Kodaira
Susumu
S
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*