scholarly journals Gastric tube volvulus following an Ivor–Lewis esophagectomy

2019 ◽  
Vol 101 (1) ◽  
pp. e1-e4 ◽  
Author(s):  
D Schizas ◽  
A Michalinos ◽  
C Vergadis ◽  
D Oikonomou ◽  
E Baili ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gastric Tube ◽  
English Literature ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Long Survival ◽  
Ivor Lewis Esophagectomy ◽  
Fourth Case ◽  
Total Esophagectomy ◽  
Rare Situation

Gastric tube conduit is the method of choice for restoring continuity of the digestive track after a partial or total esophagectomy. Redundant gastric conduit (i.e. an elongated, floppy conduit) is a rare cause of dysphagia in patients with long survival. Gastric tube volvulus is exceedingly rare with only three cases described in the literature. We present the diagnostic and therapeutic course of a 57-year-old man who presented to our department with gastric tube volvulus 32 months after an Ivor–Lewis esophagectomy. Diagnosis was made with computed tomography and volvulus was reduced endoscopically. To the best of our knowledge, this is only the fourth case of gastric tube volvulus described in the English literature. This rare situation might be a consequence of a redundant gastric tube. Endoscopic volvulus decompression was successful in our case.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

scholarly journals Two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy

2017 ◽  
Vol 23 (45) ◽  
pp. 8035-8043 ◽  
Author(s):  
Yu Liu ◽  
Ji-Jia Li ◽  
Peng Zu ◽  
Hong-Xu Liu ◽  
Zhan-Wu Yu ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Step Method ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

PS01.204: ANASTOMOTIC LEAKS AFTER IVOR-LEWIS ESOPHAGECTOMY: INDOCYANINE GREEN NEAR-INFRERED ANGIOGRAPHY FOR GASTRIC CONDUIT BLOOD SUPPLY EVALUATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Paolo Parise ◽  
Andrea Cossu ◽  
Leonardo Garutti ◽  
Francesco Puccetti ◽  
Ugo Elmore ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Blood Supply ◽  
Near Infrared ◽  
Conflicts Of Interest ◽  
Gastric Conduit ◽  
Smoking History ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Group A ◽  
Group B

Abstract Background Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer. Methods This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed. Results Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes. Conclusion Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited. Disclosure All authors have declared no conflicts of interest.

Distal gastrectomy for early gastric conduit carcinoma after Ivor–Lewis esophagectomy

2020 ◽  
Author(s):  
Motohiro Hirao ◽  
Takuya Hamakawa ◽  
Kazuhiro Nishikawa ◽  
Koji Takami ◽  
Takeshi Kato ◽  
...  
Keyword(s):  
Distal Gastrectomy ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

scholarly journals Thoracoscopic management of volvulus of the gastric conduit following minimally invasive Ivor-Lewis esophagectomy

2015 ◽  
Vol 30 (7) ◽  
pp. 3098-3098
Author(s):  
Jeremy Linson ◽  
Michael Latzko ◽  
Bestoun Ahmed ◽  
Ziad Awad
Keyword(s):  
Minimally Invasive ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Effect of Pyloroplasty on Gastric Conduit Emptying and Patients' Quality of Life After Ivor Lewis Esophagectomy

2020 ◽  
Author(s):  
Carlo Alberto De Pasqual ◽  
Jacopo Weindelmayer ◽  
Laura Gobbi ◽  
Luca Alberti ◽  
Alessandro Veltri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Ivor-Lewis Esophagectomy With and Without Laparoscopic Conditioning of the Gastric Conduit

2010 ◽  
Vol 34 (4) ◽  
pp. 738-743 ◽  
Author(s):  
Wolfgang Schröder ◽  
Arnulf H. Hölscher ◽  
Marc Bludau ◽  
Daniel Vallböhmer ◽  
Elfriede Bollschweiler ◽  
...  
Keyword(s):  
Gastric Conduit ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

RA01.08: LAPAROSCOPIC ROUX-EN-Y GASTROJEJUNOSTOMY FOR GASTRIC CONDUIT OUTLET OBSTRUCTION FOLLOWING ESOPHAGECTOMY FOR CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Daniele Bernardi ◽  
Matteo Porta ◽  
Emanuele Asti ◽  
Veronica Lazzari ◽  
Chiara Ceriani ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Conflicts Of Interest ◽  
Outlet Obstruction ◽  
Gastric Conduit ◽  
Long Term Results ◽  
Ivor Lewis ◽  
Gastric Emptying Scintigraphy ◽  
Ivor Lewis Esophagectomy ◽  
Swallow Study

Abstract Description After Ivor Lewis esophagectomy, gastric outlet obstruction refractory to prokinetic therapy and/or endoscopic pyloric dilatation is a challenging clinical problem. Thoracoscopic implant of a gastric neurostimulator has been reported to be effective, but long-term results are lacking. The patient, a 57-year-old woman, underwent a Ivor Lewis esophagectomy for T1N0 adenocarcinoma in 2007. Postoperatively, the patient complained of persistent dysphagia, regurgitation, and 29-kg weight loss. A mechanical obstruction was ruled out by barium swallow study and upper gastrointestinal endoscopy. Several conservative attempts with prokinetic agents and endoscopic dilatations failed, and the patient was exclusively fed through jejunostomy until the thoracoscopic implant of a gastric neurostimulator in October 2015. The postoperative course was uneventful. At six-months follow-up, the patient was able to assume a soft diet and reported a weight gain of 3 kg, with a significant improvement of the total symptom score and gastric emptying scintigraphy. Nevertheless, this encouraging clinical benefit gradually disappeared after the first year of follow-up. At the beginning of 2017, the patient experienced persistent episodes of vomiting and returned to jejunostomy feeding. The video shows the technique of laparoscopic Roux-en-Y gastrojejunostomy. After adhesiolysis and transhiatal mobilization of the distal gastric conduit, a 50 cm long Roux-en-Y alimentary limb was fashioned and anastomosed to the antrum. Post-operative course was uneventful and a gastrographin swallow study showed a satisfactory emptying of the conduit. At the 3-month follow-up the patient was able to resume a soft oral diet. Laparoscopic Roux-en-Y gastrojejunostomy appears to be safe and effective in treating refractory gastric outlet obstruction following Ivor-Lewis esophagectomy. Disclosure All authors have declared no conflicts of interest.

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