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. 2003 Jun;125(6):1306-12.
doi: 10.1016/s0022-5223(02)73407-7.

Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube

Yoshifumi Ikeda  1 , Shoichi Tobari, Masanori Niimi, Shigenao Kan, Hiroshi Takami, Susumu Kodaira
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Free article

Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube

Yoshifumi Ikeda et al. J Thorac Cardiovasc Surg. 2003 Jun.
Free article

Abstract

Objectives: An extra-anatomic reconstruction would be beneficial in preventing recurrent malignant dysphagia. A long gastric tube that allowed a sufficient blood flow was necessary to perform the successful cervical anastomosis through the retrosternal route.

Methods: The gastric tube was created by means of separate division and closure of the seromuscular and submucosal-mucosal layers (stepwise group) in 15 consecutive patients and by means of full-thickness cutting of the stomach and closure of the seromuscular layer (standard group) in 22 patients. We compared these 2 types of gastroplasties in terms of total length of the tube, blood flow, and the incidence of anastomotic leakage. Blood flow was measured with a laser Doppler flowmeter during surgical intervention.

Results: The gastric tube in the stepwise group was significantly longer than that in the standard group (P <.01, unpaired t test). Tissue blood flow at the site of anastomosis in the stepwise group was significantly greater than that in the standard group (P <.01, unpaired t test), and the rate of anastomotic leakage in the stepwise group was significantly lower than that in the standard group (P <.05, chi(2) test).

Conclusion: We consider this technique to be a useful procedure for retrosternal reconstruction after subtotal esophagectomy.

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