Total removal of the posterior mediastinal gastric conduit due to gastric cancer after esophagectomy

2004 ◽  
Vol 85 (4) ◽  
pp. 204-208 ◽  
Author(s):  
Hirofumi Akita ◽  
Yuichiro Doki ◽  
Osamu Ishikawa ◽  
Ko Takachi ◽  
Isao Miyashiro ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Conduit ◽  
Total Removal ◽  
Posterior Mediastinal

scholarly journals Endoscopic submucosal dissection to relieve a flexure of the gastric conduit after esophagectomy

2018 ◽  
Vol 06 (03) ◽  
pp. E350-E353
Author(s):  
Katsumi Yamamoto ◽  
Hiroshi Noro ◽  
Yu Sato ◽  
Akira Kusakabe ◽  
Nobuyuki Tatsumi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Examination ◽  
Gastric Conduit ◽  
Endoscopic Balloon Dilation ◽  
Effective Treatment Option ◽  
Submucosal Dissection ◽  
First Case ◽  
Posterior Mediastinal ◽  
Endoscopic Balloon

Abstract Background and study aims A 70-year-old-man underwent an esophagectomy and posterior mediastinal reconstruction for esophageal cancer that was curatively resected. Although the patient was allowed to eat after surgery, he repeatedly vomited after drinking water or eating meals and required continuous hospitalization. An upper gastrointestinal series and endoscopic examination revealed an obstruction due to the flexure of the gastric conduit, which was repeatedly treated with endoscopic balloon dilation. Endoscopic balloon dilation was completely ineffective, however, because the obstruction was not due to a small lumen diameter, but rather to severe flexure. We hypothesized that the power of contraction provided by ulcer scar formation after mucosal resection could straighten the flexure, and thus removed a piece of the mucosa 8 cm in diameter on the oral side of the flexure by endoscopic submucosal dissection (ESD) 4 months after the esophagectomy. Endoscopic examination on post-ESD Day 10 revealed that the gastric conduit flexure was straightened due to ulcer scarring, and obstruction at the flexure opened over time. Meals were restarted and the patient could eat without vomiting. He was discharged from the hospital 5 weeks after ESD. This is the first case report of obstruction due to flexure of the gastric conduit after esophagectomy that was successfully treated with mucosectomy using ESD. Mucosectomy using ESD may be an effective treatment option for obstruction due to flexure of the gastric conduit after esophagectomy.

scholarly journals Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sato ◽  
Satoru Motoyama ◽  
Akiyuki Wakita ◽  
Yuta Kawakita ◽  
Yushi Nagaki ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Gastric Conduit ◽  
University Hospital ◽  
Logistic Analysis ◽  
Handsewn Anastomosis ◽  
Surgical Sutures ◽  
Posterior Mediastinal

Abstract The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326–277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

383 LAPAROSCOPIC CREATION OF RETROSTERNAL ROUTE FOR GASTRIC CONDUIT RECONSTRUCTION; SAFE AND FEASIBLE PROCEDURE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Manabu Horikawa ◽  
Taro Oshikiri ◽  
Yu Kitamura ◽  
Kazumasa Horie ◽  
Gosuke Takiguchi ◽  
...  
Keyword(s):  
Early Period ◽  
Injury Rate ◽  
Dorsal Side ◽  
Gastric Conduit ◽  
Safe Procedure ◽  
First Choice ◽  
Posterior Mediastinal ◽  
Time Required ◽  
Pleural Injury ◽  
Internal Thoracic Vessels

Abstract   Reconstruction routes after esophagectomy include posterior mediastinal, retrosternal, and subcutaneous route. We have performed posterior mediastinal reconstruction, but this route has higher risks of gastro-tracheal fistula and hiatal hernia. To avoid these complications, now we take the retrosternal route as our first choice by creating the route laparoscopically before pulling-up gastric conduit. We report the successful and safe procedure. Methods We performed laparoscopic creation of retrosternal route in 13 thoracoscopic/robot-assisted minimally invasive esophagectomies since August 2019. In practice, a peritoneal incision at the dorsal side of the xiphoid process is started. Then, via 12 mm port on the surgeon's right hand inserted slightly to the right and cranial side of the umbilical camera port, we dissect loose connective tissues from the caudal side to the cranial side behind the sternum and inside the internal thoracic vessels as landmarks. The time required to create the route and pleural injury rate during the procedure was examined. Results Thirteen cases were divided into two groups as early period group (seven cases) and later period group (six cases) respectively. The time required for route creation was 31.3 minutes(average) in the early period group, and 16.7 minutes in the later period group. There is tendency towards faster in later period group than in earlier one. The overall pleural injury rate was 15% (2 of 13 cases). Although it was difficult to determine the amount of bleeding, it was visually observed that the bleeding during the route creation was lower in the later period group than in the early period group. Conclusion The entire laparoscopic procedure to create retrosternal route makes it easier to observe and preserve the pleura and internal thoracic vessels compared to blind blunt dissection. As a conclusion, laparoscopic creation of retrosternal route for gastric conduit reconstruction is safe and feasible with good learning curve. Video https://www.dropbox.com/sh/p0wc3x46n33jp23/AADwiWHYIEUNUX6qZsERVIOga?dl=0.

29 SIZE OF THE THORACIC INLET SPACE AS A PREDICTOR OF CERVICAL ANASTOMOTIC LEAK AFTER RETROSTERNAL RECONSTRUCTION FOLLOWING ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinsuke Sato ◽  
Eiji Nakatani ◽  
Kazuya Higashizono ◽  
Erina Nagai ◽  
Yusuke Taki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Anastomotic Leak ◽  
Vertebral Body ◽  
Independent Predictor ◽  
Gastric Conduit ◽  
Distance Ratio ◽  
Thoracic Inlet ◽  
Cutoff Value ◽  
Posterior Mediastinal ◽  
Spearman’S Correlation

Abstract   Although anastomotic leak is a common postoperative complication following an esophagectomy, it is not well known whether anatomical factors increase the risk for anastomotic leak after the procedure. The purpose of this study was to clarify whether a narrow thoracic inlet is an independent predictor of cervical anastomotic leak after retrosternal reconstruction following esophagectomy. Methods A total of 212 patients who underwent esophagectomy with gastric conduit retrosternal reconstruction between January 2013 and March 2019 were included in this study. Computed tomography was used to measure the thickness of the sternum (TS), the thickness of the clavicle (TC), the interclavicular distance, the sternum-trachea distance (STD), the sternum-vertebral body distance (SVD), and the sternum-trachea distance/sternum-vertebral body distance ratio (STD/SVD ratio). The correlation between various factors was analyzed using Spearman’s correlation coefficient. Tree-based analysis was performed to define cutoff values. Multivariate logistic regression was used to analyze the association between various predictors and anastomotic leak. Results Anastomotic leak occurred in 26 patients (12.26%). Tree-based analysis identified an optimal TS cutoff value of 20.84 mm, a TC cutoff value of 23.63, and a STD/SVD ratio cut off value of 0.2138 to predict anastomotic leak. There were significant associations between the STD, STD/SVD ratio and thoracic inlet area (STD × ICD). According to multivariate analysis, STD/SVD ratio, TS, TC, and diabetes mellitus were significantly associated with increased incidence of anastomotic leak. Conclusion STD/SVD ratio, TS, TC, and diabetes mellitus were associated with higher rates of cervical anastomotic leak after retrosternal gastric conduit reconstruction following esophagectomy. In patients with a small thoracic inlet, posterior mediastinal reconstruction and intrathoracic anastomosis should be considered.

Modification of the Electron Microscope for Investigation of Fully Hydrated Biological Specimens

1969 ◽  
Vol 27 ◽  
pp. 418-419 ◽  
Author(s):  
R. C. Moretz ◽  
D. F. Parsons
Keyword(s):  
Electron Beam ◽  
Electron Microscope ◽  
Structural Damage ◽  
Lower Percentage ◽  
Vacuum Drying ◽  
Total Removal ◽  
Total Absence ◽  
Biological Studies ◽  
Electron Microscopes ◽  
Beam Damage

Short lifetime or total absence of electron diffraction of ordered biological specimens is an indication that the specimen undergoes extensive molecular structural damage in the electron microscope. The specimen damage is due to the interaction of the electron beam (40-100 kV) with the specimen and the total removal of water from the structure by vacuum drying. The lower percentage of inelastic scattering at 1 MeV makes it possible to minimize the beam damage to the specimen. The elimination of vacuum drying by modification of the electron microscope is expected to allow more meaningful investigations of biological specimens at 100 kV until 1 MeV electron microscopes become more readily available. One modification, two-film microchambers, has been explored for both biological and non-biological studies.

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