[Basic technique for reconstruction after esophagectomy]

The stomach as a conduit after esophagectomy is preferred to the colon because it is much simpler to prepare and involves only 1 anastomosis. The following principles should be followed in preparing the stomach as an esophageal substitute: the complete removal of lymphatics within the left gastric area, and careful preservation of the gastric intramural vascular network. The line of resection, where the vessels of the left gastric area enter the gastric wall, should be cautiously decided. Border between the left and right gastric area of the lesser curvature is identified by the courses of these arteries. The 1st GIA should be inserted slightly toward the caudal side, and the 2nd GIA should be fired along the resection-line. The final GIA should be advanced to the highest point. The space beneath the sternum in the anterior mediastinum is easily created with minimal blood loss. The space is initially created by blunt finger dissection through the abdominal and cervical incisions, and further developed by insertion of a flat malleable intestinal retractor with a hole on 1 side, which is useful for elevating the esophageal substitute without a twist.