Surgical optimisation of the gastric conduit for minimally invasive oesophagectomy

Abstract

Surgical modification of a three-stage minimally invasive oesophagectomy technique, with the further incorporation of laparoscopic ischaemic conditioning and extracorporeal conduit formation, reduces gastric conduit morbidity, allowing the potential benefits of this approach to be realised.

Fluoroscopically Guided Balloon Dilation or Temporary Stent Placement for Patients With Gastric Conduit Strictures After Esophagectomy With Esophagogastrostomy

“…Despite relatively high complication (33.3%) and recurrence (83.3%) rates, management using fluoroscopically guided balloon dilation and stent placement appears to be an effective treatment of strictures in the gastric conduit. In the past, early surgical revision was recommended for treatment of ischemic strictures, because of concern for development of conduit necrosis [9,15]. However, by application of the management protocol described here, high technical (100%) and clinical (91.6%) success rates were achieved in the present study.…”

“…Despite these apparent improvements, however, some studies have reported a high incidence of ischemia-related complications such as formation of strictures in unexpected locations [7][8][9][10]. Unlike ordinary postoperative strictures at the anastomotic site, the strictures developed at the gastric conduit, below the anastomosis, with relatively long segmental strictures, rang-OBJECTIVE.…”

“…As an alternative, minimally invasive esophagectomy and robotassisted surgery have been developed to minimize postoperative side effects, such as compromised pulmonary function [4,5]. Early outcomes were outstanding, showing substantial decreases in terms of blood loss, postoperative pain, and respiratory complications [4,6].Despite these apparent improvements, however, some studies have reported a high incidence of ischemia-related complications such as formation of strictures in unexpected locations [7][8][9][10]. Unlike ordinary postoperative strictures at the anastomotic site, the strictures developed at the gastric conduit, below the anastomosis, with relatively long segmental strictures, rang-OBJECTIVE.…”

Ischemic Conditioning of the Stomach in the Prevention of Esophagogastric Anastomotic Leakage After Esophagectomy

“…Cross-reference investigation increased the number of pertinent reports to 38. There were 11 animal studies [18][19][20][21][22][23][24][25][26][27][28]; of the 16 clinical studies, IC was achieved with PAE in five [29][30][31][32][33] and with laparoscopy in the remaining 11 studies [9,10,[34][35][36][37][38][39][40][41][42]. A recent meta-analysis [17] evaluated the results of the 12 clinical comparative studies [10, 29-33, 36, 40, 42].…”

“…Older series report a high incidence of esophagogastric leakage, reaching to one third of the cases [7,8]. Despite improvements and modifications in the creation of the gastric conduit and in the technique of the anastomosis, reported leakage rates of modern series still remain high [9][10][11][12][13].…”