title: Reconstruction after esophagectomy in patients with [partial] gastric resection. Case report and review of the literature of the use of remnant stomach.
abstract: BACKGROUND
  Bowel reconstruction after subtotal esophagectomy represents a problem when a previous distal gastrectomy was performed: usually the colon or jejunum is used.
  
  
  METHODS
  In a 10 year period 126 patients with primary esophageal cancer underwent esophageal resection in our Department. Surgical procedures were 57% two-phase subtotal oesophagectomy, 23% transhiatal, 9% stripping, 10 three-phase total esophagectomy and 2 endoscopic resections.
  
  
  RESULTS
  In 112 patients alimentary tract reconstruction was achieved by means of esophago-gastric anastomosis. Reconstruction was performed using colon in 10 cases and jejunum in 2. We describe the technical aspects of esophagectomy and gastric reconstruction in a patient with previous antrectomy and Billroth II reconstruction. The procedure was performed via a combined laparotomy and thoracotomy with anastomosis at the level of the azygous vein using the remnant stomach.
  
  
  CONCLUSIONS
  Few technical reports have been reported in literature about the use of remnant stomach in reconstruction for subtotal esophagectomy subsequent to distal gastrectomy. Several hypotheses are made to explain the maintenance of the gastric vascular integrity as its intramural network without micro-vascular anastomosis.
authors.affiliation: Department of Surgical Sciences, University of Insubria, Varese, Italy. gianlorenzo.dionigi@uninsubria.it
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Giulio
authors.initials: G
authors.lastname: Carcano