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Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube
Yoshifumi Ikeda1, Shoichi Tobari, Masanori Niimi
1Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. yikeda@med.teikyo-u.ac.jp
Objectives:
An extra-anatomic reconstruction would be beneficial in preventing recurrent malignant dysphagia. A long gastric tube that allowed a sufficient blood flow was necessary to perform the successful cervical anastomosis through the retrosternal route.
Methods:
The gastric tube was created by means of separate division and closure of the seromuscular and submucosal-mucosal layers (stepwise group) in 15 consecutive patients and by means of full-thickness cutting of the stomach and closure of the seromuscular layer (standard group) in 22 patients. We compared these 2 types of gastroplasties in terms of total length of the tube, blood flow, and the incidence of anastomotic leakage. Blood flow was measured with a laser Doppler flowmeter during surgical intervention.
Results:
The gastric tube in the stepwise group was significantly longer than that in the standard group (P <.01, unpaired t test). Tissue blood flow at the site of anastomosis in the stepwise group was significantly greater than that in the standard group (P <.01, unpaired t test), and the rate of anastomotic leakage in the stepwise group was significantly lower than that in the standard group (P <.05, chi(2) test).
Conclusion:
We consider this technique to be a useful procedure for retrosternal reconstruction after subtotal esophagectomy.