A novel technique for gaining extra length of the abdominal esophagus.
During gastrectomies for carcinomas of the esophagogastric junction, it is often desirable to gain additional length of the abdominal esophagus to construct an intra-abdominal esophagojejunal anastomosis. In this report, we describe a technique of esophageal mobilization that combines transhiatal dissection with transection of both vagus nerves at 3 points: first, at a level 2 cm to 3 cm below tracheal bifurcation; second, 3 cm to 5 cm above the hiatus; and, finally, at the level of the hiatus. Using this technique in 11 patients with carcinoma of the esophagogastric junction, we achieved lengthening of the abdominal esophagus by 3.7 cm +/- 1.2 cm (mean +/- standard deviation). In all cases, the additional esophageal length permitted the completion of an oncologically adequate resection and the execution of a safe intra-abdominal esophagojejunal anastomosis.
Arkadopoulos
Nikolaos
N
2nd Department of Surgery, University of Athens, Medical School, Aretaieion Hospital, Athens, Greece. narkado@otenet.gr
Marinis
Athanasios
A
Dafnios
Nikolaos
N
Theodosopoulos
Theodosios
T
Smyrniotis
Vassilios
V
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome