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Reconstruction of upper digestive tract: reducing morbidity by laparoscopic pull-up
Aureo L DePaula1, Antonio L V Macedo, Claudio R Cernea
1Department of Surgery, Albert Einstein Jewish Hospital, São Paulo, Brazil.
Background:
Gastric pull-up is a useful method for reconstruction of the upper digestive tract, with considerable morbidity/mortality, especially in esophageal cancers (EC).
Objective:
To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopy, in a series of 120 patients with EC.
Study Design:
Retrospective.
Patients And Methods:
From 1992 to 2004, 120 EC [cervical/cervicothoracic (3.0%), middle third (15.0%), and inferior third (82.0%)]. Most were squamous cell carcinomas (47.0%) and adenocarcinomas (34.0%). Stomach was dissected and mobilized exclusively by laparoscopy. Occasionally, laparoscopic approach was extended cranially, until connecting with cervical dissection. In other cases, dissection of thoracic esophagus was accomplished through a thoracoscopic approach.
Results:
Eighty-one patients (68.0%) had LGPU; 39 (32.0%) needed thoracoscopy. Mortality was 5.9%. Complications were fistula (10.0%) and pneumonia (10.0%). All fistulae closed spontaneously; 89.2% of patients could swallow a normal oral diet.
Conclusion:
Low morbidity/mortality of LGPU for EC compared favorably with conventional techniques.
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