Creation of gastric conduit free-graft with intraoperative perfusion imaging during pancreaticoduodenectomy in a patient post esophagectomy.
As surgery becomes more successful for complicated malignancies, patients survive longer and can unfortunately develop subsequent malignancies. Surgical resection in these settings can be treacherous and manipulations of the patient's anatomy need to be closely considered before embarking on major operations. We report a case of a patient who survived esophageal resection for locally advanced esophageal cancer only to develop a new pancreatic head malignancy. Careful upfront planning allowed for a successful resection with an uncomplicated recovery. She underwent open pancreaticoduodenectomy, and to maintain perfusion to the gastric conduit a microvascular anastomosis of the gastroepiploic pedicle was performed to the middle colic vessels. Intraoperative fluorescent imaging was used to evaluate the anastomosis as well as gastric and duodenal perfusion during the case.
Division of General Surgery, Stony Brook, New York, USA. Electronic address: spyros.md@gmail.com.
Spyridon
S
Pagkratis
Division of General Surgery, Stony Brook, New York, USA.
Dimitrios
D
Virvilis
Division of General Surgery, Stony Brook, New York, USA.
Brett T
BT
Phillips
Division of Upper Gastrointestinal and Surgical Oncology, Stony Brook, New York, USA.
Philip Q
PQ
Bao
Division of Plastic and Reconstructive Surgery, Stony Brook, New York, USA.
Sami U
SU
Khan
Division of Plastic and Reconstructive Surgery, Stony Brook, New York, USA.
Jason C
JC
Ganz
Division of Upper Gastrointestinal and Surgical Oncology, Stony Brook, New York, USA.
Kevin T
KT
Watkins
Esophagectomy; Gastric conduit; Gastrointestinal surgery; Intraoperative fluorescence imaging; Pancreaticoduodenectomy