title: Reconstruction Using a Pedunculated Gastric Tube with Duodenal Transection After Esophagectomy and Pharyngolaryngectomy.
abstract: BACKGROUND
  Gastric conduit ischemia is sometimes correlated with anastomosis-related morbidities after esophagectomy and pharyngolaryngectomy.1 (-) 5 A lack of connection between the right and left gastroepiploic vessels and intraoperative injury to these vessels could cause conduit ischemia. In addition, tensioned anastomosis due to a short gastric tube also could contribute to anastomotic leaks. This report introduces a reconstruction technique using a pedunculated gastric tube with duodenal transection for these cases.
  
  
  METHODS
  Creation of a gastric tube in the greater curvature of the stomach is performed with linear staplers. Only the right gastroepiploic vessels are preserved. The gastric tube is finally fashioned with a width of approximately 4 cm. The peripheral right gastroepiploic vessels to the pylorus are sacrificed. After the bulbs are transected, a pedunculated gastric tube is moved, with confirmation whether it has sufficient length for anastomosis in the neck. After the anal side of the gastric tube is transected, Roux-en-Y gastrointestinal anastomosis is performed. Finally, esophagogastric or pharyngogastric anastomosis is performed.
  
  
  RESULTS
  Between November 2011 and September 2014, 18 patients underwent the reported reconstruction technique due to short gastric tubes in 10 patients and a lack of connection between the right and left gastroepiploic vessels in 8 patients. Anastomotic leaks occurred in three patients (16.7 %), conduit necrosis in no patients, and strictures in no patients, respectively. Two patients had an anastomotic grade 2 leak, and one patient had an anastomotic grade 3 leak.
  
  
  CONCLUSIONS
  The current reconstruction technique is a good alternative for patients at risk of conduit ischemia and patients with a short gastric tube after esophagectomy and pharyngolaryngectomy.
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Naoya
authors: N
authors: Yoshida
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Yoshifumi
authors: Y
authors: Baba
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Eri
authors: E
authors: Oda
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Keisuke
authors: K
authors: Kosumi
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Takatsugu
authors: T
authors: Ishimoto
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Yukiharu
authors: Y
authors: Hiyoshi
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Shiro
authors: S
authors: Iwagami
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Junji
authors: J
authors: Kurashige
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Yasuo
authors: Y
authors: Sakamoto
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Yuji
authors: Y
authors: Miyamoto
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Hidetaka
authors: H
authors: Sugihara
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Kojiro
authors: K
authors: Eto
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan.
authors: Kazuto
authors: K
authors: Harada
authors: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan. hdobaba@kumamoto-u.ac.jp.
authors: Hideo
authors: H
authors: Baba
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D004386:Duodenum / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D013270:Stomach / Q000601:surgery*; D013524:Surgical Flaps