[Gastroesophageal patching with a jejunal loop in subtotal resections of the stomach]

The authors present a technical variant for re-establishing transit following sub-total gastric resections performed for extensive juxta-cardial lesions in which exeresis on the gastric wall also involves the right side of the terminal oesophagus. A "patch" of anastomotic jejunal loop is used in which the right segment of the assembly (the oesophagus and the right side of the gastric portion) does not take a direct part to the formation of the stoma. Two cases of gastric carcinoma are presented in which the extension of the lesions made necessary a strictly oesocardial proximal sectioning. The technique provides a wide stoma, without any risks of oesocardial obstruction. The method can be used in the gastric ulcers that are sited immediately under the cardia, allowing a sub-total resection with extirpation for the lesion. The authors suggest the use of this technique for the lesions high on the small curvature that cannot be extirpated with the classical technique due to the risk of stenosis of the cardial stoma as a result of the preparation of the oeso-cardial assembly. In this way the disadvantages of the exclusion technique introduced by Kelling and Madlener are avoided, as well as the risks of the high polar gastrectomy practiced by the Deloyers technique.