Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: A retrospective propensity score matched comparative study with 613 patients

Blood flow ratio in the gastric conduit measured by laser Doppler flowmetry: A predictor of anastomotic leakage after esophagectomy

“…Lai et al also reported that the area proximal to the anastomosis might affect the blood supply, thus influencing anastomotic healing. 26 In fact, the ES anastomosis requires blood flow not only from the distal side but also from the proximal side because the suturing of the ES anastomosis includes both the distal and proximal sides of the gastric conduit (Figure S2). The blood flow ratio at the anastomotic site may mainly reflect the blood flow from the distal side, and that at the tip of the gastric conduit may indicate the blood flow in the proximal part of the ES anastomosis.…”

“…A narrow gastric conduit was often selected because it can allow maximal extension of the length, effectively promote gastric emptying, and significantly reduce postoperative gastroesophageal reflux. 26,28 However, Lai et al reported a higher occurrence of anastomotic leakage for patients who underwent reconstruction using a narrow gastric conduit rather than a gastric conduit with a 5-cmwide proximal end. 26 During this study, the blood supply to zone III seemed to occur through a microscopic network of capillaries and arterioles.…”

“…26,28 However, Lai et al reported a higher occurrence of anastomotic leakage for patients who underwent reconstruction using a narrow gastric conduit rather than a gastric conduit with a 5-cmwide proximal end. 26 During this study, the blood supply to zone III seemed to occur through a microscopic network of capillaries and arterioles. Because some of the submucosal vessels in the gastric wall were resected in the narrow gastric conduit, a gastric conduit with a wide proximal end might preserve the blood flow via the gastric wall and decrease the incidence of anastomotic leakage after esophagectomy, 26 thus supporting our finding that preserving the blood supply through the gastric wall could be important to reducing leakage.…”

“…Lai et al. also reported that the area proximal to the anastomosis might affect the blood supply, thus influencing anastomotic healing 26 . In fact, the ES anastomosis requires blood flow not only from the distal side but also from the proximal side because the suturing of the ES anastomosis includes both the distal and proximal sides of the gastric conduit (Figure S2).…”

“…A narrow gastric conduit was often selected because it can allow maximal extension of the length, effectively promote gastric emptying, and significantly reduce postoperative gastroesophageal reflux 26,28 . However, Lai et al.…”