Additional microvascular anastomosis in reconstruction after total esophagectomy for cervical esophageal carcinoma

Intraoperative Thermal Imaging in Esophageal Replacement: Its Use in the Assessment of Gastric Tube Viability

“…At this point, we recommend surgeons to consider the options of more distal gastric tube resection, use of jejunal or colonic interposition, or supercharging the gastric tube when the surface temperature of the proximal gastric tube is extremely low. [20][21][22][23] On the other hand, we found that patients with anastomotic stricture had relatively low the surface temperature at the proximal gastric tube from those without stricture (27.1°C vs 28.1°C). If anastomotic stricture can be caused by poor blood supply at the anastomosis site, then this result stands to reason and prostaglandin E 1 administration, which has been proven for the augmentation in the microcirculation of the gastric tube, might prevent minor anastomotic leakage or anastomotic stricture when the surface temperature of proximal gastric tube is relatively low.…”

Pancreaticoduodenectomy After Esophageal and Gastric Surgery Preserving Right Gastroepiploic Vessels

“…In the supercharge technique for esophageal reconstruction, which vessel is more important-artery, vein, or both-is still under debate. Some investigators regard the artery as being more important, 13,14 others consider the vein more important, 15 and yet others consider both equally important. 16 In our series, because the RGEA and RGEV were the only major pathways for arterial blood supply and venous drainage, respectively, we were concerned that their sacrifice would cause necrosis of the remnant stomach through ischemia and/or congestion, which would be critical in these cases.…”

Postoperative recovery of microcirculation after gastric tube formation

“…The disadvantage of this procedure is an incomplete lymphadenectomy along the lesser curvature and the left gastric artery, which are known to be the major sites of abdominal [18,19]. Another surgical technique is the formation of additional microvascular anastomoses to the upper part of the gastric conduit, which increases the arterial and venous flow along the arcade of the greater curvature [20]. This option requires special microsurgical skills and extends the operation time considerably.…”