title: Esophageal replacement following gastric devascularization is safe, feasible, and may decrease anastomotic complications.
abstract: BACKGROUND
  Gastric transposition is the most common reconstruction after esophagectomy. Despite technical improvements, the incidence of anastomotic complications remains high. Gastric devascularization followed by esophageal resection and reconstruction has been proposed to minimize these complications.
  
  
  METHODS
  Thirty-two patients underwent minimally invasive esophagectomy, and seven high-risk patients were selected for laparoscopic gastric devascularization performed either 1 week (n = 5) or 12 weeks (n = 2) before esophageal resection. Primary outcomes included anastomotic leak and stricture.
  
  
  RESULTS
  Each patient underwent successful laparoscopic devascularization and subsequent esophagectomy. Devascularization required an average of 134 minutes with minimal operative blood loss. There were no complications following gastric devascularization or directly attributable to delay. None of the delay patients developed an anastomotic leak, compared to 16% of patients after immediate reconstruction (p = 0.258). One patient (14%) developed an anastomotic stricture that required endoscopic dilatation within the first year after surgery, compared to 12% of immediate reconstruction patients (p = 0.872).
  
  
  CONCLUSIONS
  In this series, all patients underwent successful delayed reconstruction following gastric devascularization without anastomotic leak. The absence of anastomotic leak in the delay group suggests that delayed conduit preparation can be accomplished safely while potentially reducing the morbidity associated with esophagectomy, but larger prospective studies are required to prove this definitively.
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH, USA. Kyle.perry@osumc.edu
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.forename: C Kristian
authors.initials: CK
authors.lastname: Enestvedt
authors.forename: Thai H
authors.initials: TH
authors.lastname: Pham
authors.forename: James P
authors.initials: JP
authors.lastname: Dolan
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D016629:Esophagectomy / Q000379:methods*; D004944:Esophagoplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications / Q000517:prevention & control; D013270:Stomach / Q000098:blood supply* / Q000601:surgery
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