Reconstruction of upper digestive tract: reducing morbidity by laparoscopic pull-up.
BACKGROUND
Gastric pull-up is a useful method for reconstruction of the upper digestive tract, with considerable morbidity/mortality, especially in esophageal cancers (EC).


OBJECTIVE
To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopy, in a series of 120 patients with EC.


METHODS
Retrospective.


METHODS
From 1992 to 2004, 120 EC [cervical/cervicothoracic (3.0%), middle third (15.0%), and inferior third (82.0%)]. Most were squamous cell carcinomas (47.0%) and adenocarcinomas (34.0%). Stomach was dissected and mobilized exclusively by laparoscopy. Occasionally, laparoscopic approach was extended cranially, until connecting with cervical dissection. In other cases, dissection of thoracic esophagus was accomplished through a thoracoscopic approach.


RESULTS
Eighty-one patients (68.0%) had LGPU; 39 (32.0%) needed thoracoscopy. Mortality was 5.9%. Complications were fistula (10.0%) and pneumonia (10.0%). All fistulae closed spontaneously; 89.2% of patients could swallow a normal oral diet.


CONCLUSIONS
Low morbidity/mortality of LGPU for EC compared favorably with conventional techniques.
DePaula
Aureo L
AL
Department of Surgery, Albert Einstein Jewish Hospital, São Paulo, Brazil.
Macedo
Antonio L V
AL
Cernea
Claudio R
CR
Schraibman
Vladimir
V
Pinus
Jacques
J
Milanez
José R
JR
Succi
José E
JE
Hojaij
Flávio C
FC
de Carlucci
Dorival
D
Nishio
Sunao
S
D000230:Adenocarcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010614:Pharynx / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D013906:Thoracoscopy; D016896:Treatment Outcome