scholarly journals Reconstruction of the esophagus of patients with middle thoracic esophageal carcinoma using the remnant stomach following Billroth II gastrectomy

2020 ◽  
Author(s):  
Zhangfan Mao ◽  
Bo Wang ◽  
Ping Dong ◽  
Gaoli Liu ◽  
Haifeng Hu ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Distal Gastrectomy ◽  
Anastomotic Stricture ◽  
Remnant Stomach ◽  
Thoracic Esophageal Cancer ◽  
Left Hemithorax ◽  
Ivor Lewis ◽  
Billroth Ii Gastrectomy ◽  
History Of ◽  
Feeding Vessels

Abstract It seems impossible to reconstruct the esophagus of patients with middle thoracic esophageal carcinoma with a history of distal gastrectomy using the remnant stomach. Although surgeons have made multiple efforts to reconstruct the esophagus using the remnant stomach, it can only be successfully used in cases of lower thoracic esophageal cancer. Additionally, the surgery is more complex than traditional esophagogastrostomy due to challenges including mobilization of the remnant stomach with the spleen and transposition of the pancreatic tail into the left hemithorax. Our operation proved that the remnant stomach, which we named as the completely mobilized remnant stomach after dissection of the feeding vessels, remained viable. We successfully integrated the completely mobilized remnant stomach in the reconstruction of the lower thoracic esophageal tract and then integrated it in Ivor Lewis esophagogastrostomy. We describe this new alternative surgical technique for the treatment of middle thoracic esophageal carcinoma in patients with a history of distal gastrectomy in this study. Clinical data of 23 patients from 2008 to 2019 were retrospectively analyzed. All patients underwent the Ivor Lewis procedure. All remaining vessels of the remnant stomach were dissected at their origins, and Roux-en-Y reconstruction or Braun anastomosis was performed. After esophagectomy during right thoracotomy, anastomosis of the remnant stomach and esophagus was performed. Two-field lymph node dissections were performed. There was no case of necrosis of the remnant stomach or of perioperative death. Serious complications included anastomotic leak in three cases, afferent-efferent loop syndrome in one, and anastomotic stricture in two. Application of the completely mobilized remnant stomach in Ivor Lewis esophagogastrostomy is feasible, and the surgical procedure is similar to that of normal esophagogastrostomy.

PS01.157: APPLICATION OF THE COMPLETELY MOBILIZED REMNANT STOMACH IN ESOPHAGOPLASTY FOR LOWER THORACIC ESOPHAGEAL CARCINOMA FOLLOWING DISTAL GASTRECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Zhangfan Mao ◽  
Jie Huang ◽  
Songping Xie
Keyword(s):  
Esophageal Carcinoma ◽  
Pulmonary Infection ◽  
Distal Gastrectomy ◽  
Conflicts Of Interest ◽  
Remnant Stomach ◽  
Billroth Ii ◽  
Billroth I ◽  
Surgical Methods ◽  
History Of ◽  
Feeding Vessels

Abstract Background Reconstruction of the esophagus for the patients following distal gastrectomy (DGE)is a significant challenge for surgeons. Remnant stomach seems to be a better choice compared with colon or jejunal. But many complicated surgical methods were performed because of limitation of feeding vessels. We found the remnant stomach remained viable when all the feeding vessels were dissected. We used the completely mobilized stomach to reconstruct esophagus successfully in 29 lower thoracic esophageal carcinoma patients with a history of DGE. Methods The clinical data of 29 patients were retrospectively analyzed from August 2005 to March 2017 who accepted esophagoplasty by the completely mobilized remnant stomach. All the vessels of the remnant stomach were dissected including short gastric, posterior gastric, left gastric and left gastroepiploic vessels. The DGE included 2 Billroth I and 27 Billroth II. Results No perioperative death, no remnant stomach necrosis occurred. One Leakage was the iatrogenic injury on the remnant stomach. The other postoperative complications were the pulmonary infection(5) and arrhythmia(4). Conclusion The completely mobilized remnant stomach was viable and functional after dissecting all the feeding vessels. Application of it was a new and feasible surgical method to perform esophagoplasty with the simpler procedure and less complication. Disclosure All authors have declared no conflicts of interest.

scholarly journals Usefulness of Fluorescence Vascular Imaging for Preserving the Remnant Stomach After Distal Pancreatosplenectomy: A Case Report

2017 ◽  
Vol 102 (3-4) ◽  
pp. 125-130
Author(s):  
Yota Kawasaki ◽  
Kosei Maemura ◽  
Hiroshi Kurahara ◽  
Yuko Mataki ◽  
Koji Minami ◽  
...  
Keyword(s):  
Blood Supply ◽  
Distal Gastrectomy ◽  
Early Stage ◽  
Remnant Stomach ◽  
Vascular Imaging ◽  
Proximal Stomach ◽  
Number Of Patients ◽  
Recent Developments ◽  
Feeding Vessels ◽  
Distal Pancreatosplenectomy

Due to recent developments in medical treatment, the number of patients that undergo multiple surgical procedures for secondary metachronous cancer is increasing. In cases in which patients undergo distal pancreatosplenectomy after distal gastrectomy, surgeons might have concerns about whether they are able to preserve the remnant proximal stomach because the main feeding vessels will have been divided in the previous procedure. Herein, we report a case in which a patient underwent distal pancreatosplenectomy 20 years after undergoing distal gastrectomy, and the remnant proximal stomach was successfully preserved with the help of intraoperative fluorescence vascular imaging using indocyanine green (FVI-ICG). A 65-year-old female was referred to our hospital due to upper gastric pain and was diagnosed with cancer of the pancreatic body. She had undergone distal gastrectomy 20 years earlier for early stage gastric cancer. Therefore, the blood supply to the remnant stomach left after the distal pancreatectomy procedure might have been insufficient. To determine the adequacy of the blood supply to the remnant proximal stomach after distal pancreatosplenectomy, we conducted intraoperative FVI-ICG. Because strong fluorescence was detected, we were able to safely preserve the remnant stomach. At 4 and 8 months after surgery, computed tomography showed good blood flow through the remnant stomach. FVI-ICG is useful for evaluating the blood supply to tissues, and hence, can be used to predict the blood supply of residual organs.

scholarly journals Rapidly Growing Desmoid-Type Fibromatosis of the Mesentery of the Small Intestine after Distal Gastrectomy for Gastric Cancer

2020 ◽  
Vol 14 (1) ◽  
pp. 197-205
Author(s):  
Ryota Koyama ◽  
Yoshiaki Maeda ◽  
Nozomi Minagawa ◽  
Toshiki Shinohara
Keyword(s):  
Gastric Cancer ◽  
Small Intestine ◽  
Lymph Node ◽  
Distal Gastrectomy ◽  
Anastomotic Site ◽  
En Bloc ◽  
Surgical History ◽  
History Of ◽  
Feeding Vessels

We report the case of a 55-year-old man with a surgical history of distal gastrectomy with Roux-en-Y reconstruction performed 3 years prior to the present episode. During the follow-up, a newly developed, rapidly growing intraabdominal mass was detected in the mesentery of the small intestine. Although the patient had been asymptomatic, surgical resection was planned with the suspicion of malignancy, especially lymph node recurrence of the gastric cancer, owing to its rapid growth. Laparotomy showed that the tumor was located in the mesentery of the small intestine near the Roux-en-Y limb, and due to the involvement of the feeding vessels to the Roux-en-Y limb, the anastomotic site was resected en bloc with the tumor, and the whole Roux-en-Y limb was reconstructed. The histopathological finding was compatible with desmoid-type fibromatosis of the mesentery of the small intestine. Here we report our case and discuss the previously reported literature, especially related to gastric cancer.

A case of using the remnant stomach as substitute after esophagectomy for esophageal cancer with history of distal gastrectomy

Esophagus ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 121-124 ◽  
Author(s):  
Masashi Takemura ◽  
Masayuki Higashino ◽  
Shinya Tanimura ◽  
Yosuke Fukunaga ◽  
Yoshinori Tanaka ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Distal Gastrectomy ◽  
Remnant Stomach ◽  
History Of

Use of the remnant stomach in reconstruction for subtotal esophagectomy subsequent to distal gastrectomy

Surgery ◽  
1995 ◽  
Vol 118 (3) ◽  
pp. 571-573 ◽  
Author(s):  
Toshiki Matsubara ◽  
Mamoru Ueda ◽  
Toshifusa Nakajima
Keyword(s):  
Distal Gastrectomy ◽  
Remnant Stomach ◽  
Subtotal Esophagectomy

The comparison of symptoms and motor function of the remnant stomach between after distal gastrectomy and pylorus preserving gastrectomy

2000 ◽  
Vol 118 (4) ◽  
pp. A1537
Author(s):  
Shinichiro Yanai ◽  
Nobuyoshi Hanyu ◽  
Koji Nkada ◽  
Akira Miyakawa ◽  
Katunori Nishikawa ◽  
...  
Keyword(s):  
Motor Function ◽  
Distal Gastrectomy ◽  
Remnant Stomach
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