Different gastric tubes in esophageal reconstruction during esophagectomy

Sun, Shaowu; Wang, Zhulin; Huang, Chunyao; Li, Kaiyuan; Liu, Xu; Fan, Wenbo; Zhang, Guoqing; Li, Xiangnan

doi:10.1007/s10388-023-01021-z

Cited by 4 publications

(2 citation statements)

References 56 publications

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“…The ndings indicate that both the wide gastric tube and the whole stomach maintain adequate blood supply, whereas the anastomosis site in the narrow gastric tube con guration exhibits signi cantly poorer vascularity. Consequently, the authors recommend the use of either a whole stomach or a wide-tube con guration to optimize anastomotic healing [3].…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic and Thoracoscopic Whole-Stomach Esophagectomy with Preoperative Pyloric Balloon Dilatation for Esophageal Cancer: A Prospective Multicenter Experience

NGUYEN,

PHAM,

LUONG

et al. 2024

Preprint

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Introduction. To mitigate gastroparesis as well as other post-operative complications, we undertook a prospective multicenter study to assess the feasibility, safety, and efficacy in the short-term outcomes of laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation.Methods. A prospective descriptive study on 37 patients with laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation from January 2019 to March 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.Results. In our study, all patients were male, with choking as the predominant symptom (45.9%). Esophageal cancer incidence was similar between middle and lower thirds. Nodules were the primary finding on esophagoscopy (48.6%). Preoperative pyloric dilation averaged 31.2 minutes without complications. Surgical duration ranged from 225 to 400 minutes (mean 305). Gastric tube fluid volume averaged 148.9 ± 110.66 ml per day. Among 34 post-operative cases underwent gastric circulation scans, most had non-dilated stomachs with efficient pyloric drug circulation. Three cases required prolonged ventilation, precluding pyloric circulation scans. Four patients developed chylous fistula, one requiring chest tube embolization. Recurrent laryngeal nerve damage occurred in 10.8% of cases.Conclusion. After evaluating esophageal cancer patients undergoing laparoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation, it was found that this procedure is safe, effective, and significantly reduces postoperative gastroparesis and related complications.

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Section: Resultsmentioning

confidence: 99%

“…numerous bene ts over employing a gastric tube, primarily due to the ample blood supply to the anastomosis and the preservation of gastric capacity [2,3].…”

mentioning

confidence: 99%

Laparoscopic and Thoracoscopic Whole-Stomach Esophagectomy with Preoperative Pyloric Balloon Dilatation for Esophageal Cancer: A Prospective Multicenter Experience

NGUYEN,

PHAM,

LUONG

et al. 2024

Preprint

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High cervical anastomosis reduces leakage-related complications after a McKeown esophagectomy

Chen,

Ding,

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Anastomotic leak (AL) is one of the most serious complications after oesophageal cancer surgery. High cervical anastomosis using narrow gastric tube based on optimized procedures has the potential to reduce the AL after McKeown oesophagectomy. METHODS A narrow gastric tube was defined as 2–2.5 cm in diameter. Meanwhile, we defined high anastomosis (HA) and normal anastomosis (NA) based on the position of intraoperative cervical anastomosis above or below the level of the inferior thyroid artery, respectively. A total of 533 patients who received McKeown oesophagectomy from March 2018 to March 2023 were included in this study, including 281 patients in the NA group and 252 patients in the HA group. Potential confounding factors in baseline characteristics were balanced by propensity score matching (PSM). RESULTS After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group harvested more lymph nodes in both total number (21.1 ± 10.0 vs.15.8 ± 7.7, p = 0.001) and thoracic part (13.5 ± 7.8 vs.10.8 ± 6.1, p = 0.005). The pathological T and TNM stage of patients in the HA group were earlier than those in the NA group (p = 0.001). Overall postoperative complications (p = 0.001), including pulmonary infection (p = 0.001), AL (p < 0.001), leakage related pyothorax (p < 0.001), recurrent laryngeal nerve palsy (p = 0.031), and pleural effusion (p < 0.001), were all significantly lower in the HA group. Finally, multivariable logistic regression analysis indicated that HA was an independent protective factor for AL (OR = 0.331, 95% CI: 0.166–0.658; p = 0.002). CONCLUSIONS For patients undergoing McKeown oesophagectomy, high cervical anastomosis using narrow gastric tube can effectively reduce leakage related complications.

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Sustitución esofágica con tubo gástrico flexible en paciente pediátrico posterior a estenosis esofágica por cáusticos

Gloria-Rivas,

Romero-Sánchez,

Farell-Rivas

2024

Rev Colomb Cir

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Introducción. Las quemaduras esofágicas por ingesta de cáusticos tienen como complicación tardía la formación de estenosis, lo que impide una adecuada alimentación debido a la imposibilidad de pasar el alimento. Para corregir esta complicación, se puede realizar una sustitución esofágica de manera quirúrgica, mediante la formación de un tubo gástrico. Caso clínico. Presentamos el caso de un paciente pediátrico con estenosis esofágica, causada por la ingesta accidental de cáusticos, que no pudo ser resuelta mediante dilataciones esofágicas por endoscopia. Se decidió proceder con la formación de un tubo gástrico “flexible”, ya que tiene mayor longitud, preserva un mejor aporte vascular y disminuye el riesgo de fuga de anastomosis generado por los sitios de isquemia. Resultado. A los dos días del posoperatorio, se realizó una serie esofagogastroduodenal con contraste hidrosoluble, donde no se observaron fugas. Posteriormente, al tercer día posoperatorio, el paciente comenzó a ingerir sólidos. Conclusión. La técnica quirúrgica utilizada para formar este tubo gástrico permite una adecuada permeabilidad vascular, evitando fugas en los sitios de anastomosis.

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Different gastric tubes in esophageal reconstruction during esophagectomy

Cited by 4 publications

References 56 publications

Laparoscopic and Thoracoscopic Whole-Stomach Esophagectomy with Preoperative Pyloric Balloon Dilatation for Esophageal Cancer: A Prospective Multicenter Experience

Laparoscopic and Thoracoscopic Whole-Stomach Esophagectomy with Preoperative Pyloric Balloon Dilatation for Esophageal Cancer: A Prospective Multicenter Experience

High cervical anastomosis reduces leakage-related complications after a McKeown esophagectomy

Sustitución esofágica con tubo gástrico flexible en paciente pediátrico posterior a estenosis esofágica por cáusticos

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