title: Roux-en-Y augmented gastric advancement: An alternative technique for concurrent esophageal and pyloric stenosis secondary to corrosive intake.
abstract: Select group of patients with concurrent esophageal and gastric stricturing secondary to corrosive intake requires colonic or free jejunal transfer. These technically demanding reconstructions are associated with significant complications and have up to 18% ischemic conduit necrosis. Following corrosive intake, up to 30% of such patients have stricturing at the pyloro-duodenal canal area only and rest of the stomach is available for rather less complex and better perfused gastrointestinal reconstruction. Here we describe an alternative technique where we utilize stomach following distal gastric resection along with Roux-en-Y reconstruction instead of colonic or jejunal interposition. This neo-conduit is potentially superior in terms of perfusion, lower risk of gastro-esophageal anastomotic leakage and technical ease as opposed to colonic and jejunal counterparts. We have utilized the said technique in three patients with acceptable postoperative outcome. In addition this technique offers a feasible reconstruction plan in patients where colon is not available for reconstruction due to concomitant pathology. Utility of this technique may also merit consideration for gastroesophageal junction tumors.
authors.affiliation: Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Punjab 54000, Pakistan.
authors.forename: Talat
authors.initials: T
authors.lastname: Waseem
authors.affiliation: Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Punjab 54000, Pakistan.
authors.forename: Asad
authors.initials: A
authors.lastname: Azim
authors.affiliation: Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Punjab 54000, Pakistan.
authors.forename: Muhammad Hasham
authors.initials: MH
authors.lastname: Ashraf
authors.affiliation: Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Punjab 54000, Pakistan.
authors.forename: Khawaja M
authors.initials: KM
authors.lastname: Azim
keywords: Colonic interposition; Corrosive strictures; Roux-en-Y augmented gastric advancement