Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy

2008 ◽  
Vol 23 (9) ◽  
pp. 2110-2116 ◽  
Author(s):  
Darmarajah Veeramootoo ◽  
Rajeev Parameswaran ◽  
Rakesh Krishnadas ◽  
Peter Froeschle ◽  
Martin Cooper ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Recognition ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Invasive Esophagectomy

384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinji Mine ◽  
Masayuki Watanabe ◽  
Atushi Kanamori ◽  
Yu Imamura ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Anterior Wall ◽  
Gastric Conduit ◽  
Linear Stapler ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Gastric Anastomosis

Abstract   Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution. Methods From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE. Procedures The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers. Results Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C. Conclusion Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.

Extracorporeal Gastric Stapling Reduces the Incidence of Gastric Conduit Failure after Minimally Invasive Esophagectomy

2010 ◽  
Vol 76 (8) ◽  
pp. 823-828 ◽  
Author(s):  
Gregory D. Crenshaw ◽  
Suven S. Shankar ◽  
Russell E. Brown ◽  
Abbas E. Abbas ◽  
John S. Bolton
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Operative Mortality ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Short Term ◽  
Simple Modification ◽  
Invasive Esophagectomy ◽  
Clinic Foundation ◽  
Significant Difference

Esophageal cancer resection is associated with significant morbidity and mortality. To date, no standardized technique exists. In this study, we analyze our short-term results in 92 minimally invasive resections performed over the past 10 years in an attempt to identify technical factors, which contribute to improved short-term outcomes. A retrospective review of 92 minimally invasive esophagectomies was performed at the Ochsner Clinic Foundation from 1999 through 2009. Data collected included preoperative stage, whether or not preoperative chemoradiation was used, technique of minimally-invasive resection, technique of esophagogastric anastomosis, margin status, anastomotic leak, conduit necrosis, gastric conduit failure of any type, and operative mortality. Gastric stapling was done either laparoscopically (intracorporeal) or through a minilaparotomy (extracorporeal). Ninety-two patients met criteria for this study. There was a significant difference in the incidence of positive gastric margins ( P = 0.04), anastomotic leak ( P = 0.045), conduit necrosis ( P = 0.03), and any gastric conduit failure ( P = 0.02) favoring the extracorporeal group. The overall short-term morbidity and operative mortality with minimally invasive esophagectomy is comparable to the results obtained with open techniques. A relatively simple modification of the operative technique—performing extracorporeal stapling of the gastric conduit—led to a significant reduction in the incidence of gastric conduit failures when compared with the intracorporeal stapling technique.

Transthoracic Extracorporeal Gastric Conduit Preparation for Minimally Invasive Ivor-Lewis Esophagectomy

2015 ◽  
Vol 10 (4) ◽  
pp. 236-240
Author(s):  
Anna L. McGuire ◽  
Sebastien Gilbert
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Laparoscopic Approach ◽  
Tumor Location ◽  
Gastric Conduit ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
Significant Difference

Objective During totally minimally invasive esophagectomy (MIE), the gastric conduit is typically constructed via laparoscopy. Trauma from laparoscopic instruments, inability to palpate the gastroepiploic arcade, and challenges in optimal positioning of the stomach for intra-abdominal stapling have led to the widespread use of laparotomy as part of hybrid MIE procedures. Our objective was to evaluate the safety of transthoracic extracorporeal gastric conduit preparation. We hypothesize that this alternative technique is equivalent in safety to the laparoscopic approach. Methods This is a retrospective comparison of laparoscopic and transthoracic extracorporeal gastric conduit preparation with regard to anastomotic and respiratory outcomes. Results During a 3-year period, 30 patients underwent MIE with a right intrathoracic anastomosis (extracorporeal conduit, 15; laparoscopic conduit, 15). Mean age (58.6 vs 67 years, P = 0.59), tumor location (gastroesophageal junction vs middle and lower esophageal, P = 0.27), and histology (adenocarcinoma vs other 26.7%, P = 0.68) were similar between groups. Anastomotic technique and operating surgeon were the same for all patients. Patients in the laparoscopic gastric conduit group were more likely to have undergone induction chemoradiotherapy (40% vs 80%, P = 0.030). There was no significant difference between groups with respect to anastomotic complications, including anastomotic leak and anastomotic stricture (20% vs 13.3%, P = 0.70). Transthoracic gastric conduit preparation was not associated with increased respiratory complications (8% vs 12%, P = 0.09). Conclusions Transthoracic gastric conduit preparation is a simple, minimally invasive alternative laparotomy for gastric conduit preparation during MIE. No additional incision is required. The technique may help surgeons overcome shortcomings of the laparoscopic approach without impacting perioperative risk.

scholarly journals Review of Minimally Invasive Esophagectomy and Current Controversies

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
T. Kim ◽  
S. N. Hochwald ◽  
G. A. Sarosi ◽  
A. M. Caban ◽  
G. Rossidis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Prone Positioning ◽  
Life Outcomes ◽  
Significant Morbidity ◽  
Operative Morbidity ◽  
Invasive Esophagectomy ◽  
Open Versus

Esophagectomy is a complex operation with significant morbidity and mortality. Minimally invasive esophagectomy (MIE) was described in the 1990s in an effort to reduce operative morbidity. Since then many institutions have adopted and described their series with this technique. This paper reviews the literature on the variety of MIE techniques, clinical and quality of life outcomes with open versus MIE, and controversies surrounding MIE—such as prone positioning, stapling techniques, size of the gastric conduit, and robotic techniques.

RA01.06: TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY IN A PATIENT WITH PREVIOUS NISSEN FUNDOPLICATION: CAN INDOCYANINE GREEN BE A USEFUL TOOL?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Victor Turrado-Rodriguez ◽  
Dulce Nombre De Maria Momblan ◽  
Alba Torroella ◽  
Ainitze Ibarzabal ◽  
Yoelimar Carolina Guzman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Prone Position ◽  
Nissen Fundoplication ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Hiatal Hernia Repair ◽  
Nerve Paralysis ◽  
Invasive Esophagectomy

Abstract Description Total esophagectomy may be technically demanding. Previous abdominal surgeries may increase the difficulty of the technique, especially when affecting the stomach as a gastric conduit is the preferred method for reconstruction. In this video, we demonstrate that the creation of the gastric conduit is feasible even with a previous Nissen fundoplication and that the use of indocyanine green (ICG) is useful to assess the vascularization of the gastric conduit. Methods A 70-year-old woman with medical history of high blood pressure, hysterectomy and hiatal hernia repair with laparoscopic Nissen fundoplication presented with symptoms of dysphagia and weight loss and was diagnosed of an adenocarcinoma of the esophagus (25 to 32 cm from the incisives) cT3N1. Neoadjuvant chemo-radiotherapy following CROSS scheme was administered. A total minimally invasive esophagectomy was performed in the prone position for the thoracic time. Concerns about the length of the gastric conduit due to the fundoplication were present during surgery. ICG was used to locate the right gastroepiploic arcade, asses the vascularization of the gastric conduit, specially in the gastric fundus, and after cervicotomy, to assess the vascularization of the gastric stump before performing the anastomosis. Results Surgical time was 360 minutes. Postoperative evolution was satisfactory except for hoarseness due to a possible right recurrent laryngeal nerve paralysis. She was discharged on the 11th postoperative day. Pathology confirmed an adenocarcinoma of the mid esophagus ypT1bN1 (1/15). Conclusions Totally minimally invasive esophagectomy in the prone position is feasible even in the case of previous upper gastrointestinal surgeries, such as Nissen fundoplication. The use of ICG is useful for the identification of the gastroepiploic arcade, assessment of the vascular supply to the gastric conduit and to the anastomosis, especially when a McKeown esophagectomy is performed. Disclosure All authors have declared no conflicts of interest.

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