Journal article
Delayed Esophagogastrostomy: A Safe Strategy for Management of Patients with Ischemic Gastric Conduit at Time of Esophagectomy
Journal of the American College of Surgeons, v 208(6), pp 1030-1034
01 Jun 2009
PMID: 19476888
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Ischemia of the gastric conduit remains an important complication of esophagectomy and is associated with an increased risk of anastomotic leak and sepsis. We report a group of patients with multiple comorbid conditions and an ischemic gastric conduit that was successfully managed by a delayed esophagogastrostomy.
STUDY DESIGN: Between 2000 and 2007, esophagectomy with gastric pullup was performed in 554 patients. In 37 patients (7%), the combination of an ischemic graft and substantial comorbid conditions prompted delayed reconstruction to avoid an immediate esophagogastrostomy, In these patients, the gastric conduit was brought up and secured in the neck, and a cervical esophagostomy was constructed. Subsequently, a delayed esophagogastrostomy was performed through neck incision. Outcomes were analyzed at a median of 22 months (interquartile range [IQR], 13 to 30 months).
RESULTS: There were 29 male and 8 female patients, with a median age of 65 years (IQR, 58 to 75 years). Thirty-one patients had malignant disease; 12 received neoadjuvant therapy. All 37 patients recovered from their esophagectomy without evidence of ischemic necrosis or fistula from their gastric conduit. In 35 patients, a delayed esophagogastrostomy was performed at a median of 98 days (IQR, 89 to 110 days). At the time of reconstruction, all had well-perfused gastric conduits, and the anastomoses healed without leak, wound infection, or sepsis. A stricture developed in three patients and was treated with dilation. Delayed esophagogastrostomy was never performed in two patients because of development of recurrent malignant disease.
CONCLUSIONS:. Delayed esophagogastrostomy is a safe strategy for management of patients with comorbidities and an ischemic gastric conduit at the time of esophagectomy. (J Am Coll Surg 2009;208: 1030-1034. (C) 2009 by the American College of Surgeons)
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Details
- Title
- Delayed Esophagogastrostomy: A Safe Strategy for Management of Patients with Ischemic Gastric Conduit at Time of Esophagectomy
- Creators
- Arzu Oezcelik - University of Southern CaliforniaFarzaneh Banki - University of Southern CaliforniaSteven R. DeMeester - University of Southern CaliforniaJessica M. Leers - University of Southern CaliforniaShahin Ayazi - University of Southern CaliforniaEmmanuele Abate - University of Southern CaliforniaJeffrey A. Hagen - University of Southern CaliforniaJohn C. Lipham - University of Southern CaliforniaTom R. DeMeester - University of Southern California
- Publication Details
- Journal of the American College of Surgeons, v 208(6), pp 1030-1034
- Publisher
- Elsevier
- Number of pages
- 5
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000267134300006
- Scopus ID
- 2-s2.0-67349256749
- Other Identifier
- 991022048378104721
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- Surgery