title: Reconstruction of upper digestive tract: reducing morbidity by laparoscopic pull-up.
abstract: 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.
authors.affiliation: Department of Surgery, Albert Einstein Jewish Hospital, São Paulo, Brazil.
authors.forename: Aureo L
authors.initials: AL
authors.lastname: DePaula
authors.forename: Antonio L V
authors.initials: AL
authors.lastname: Macedo
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Cernea
authors.forename: Vladimir
authors.initials: V
authors.lastname: Schraibman
authors.forename: Jacques
authors.initials: J
authors.lastname: Pinus
authors.forename: José R
authors.initials: JR
authors.lastname: Milanez
authors.forename: José E
authors.initials: JE
authors.lastname: Succi
authors.forename: Flávio C
authors.initials: FC
authors.lastname: Hojaij
authors.forename: Dorival
authors.initials: D
authors.lastname: de Carlucci
authors.forename: Sunao
authors.initials: S
authors.lastname: Nishio
mesh_terms: 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