Retrograde stapling of a free cervical jejunal interposition graft: a technical innovation and case report

BMC Surgery

Marc H Dahlke⁴  Hans J Schlitt⁴  Thomas Kühnel⁵  Lukas Prantl³  Jurgen Dolderer³  Martin Loss⁴  Philipp Renner⁴  Volker Benseler⁴  Lena-Marie Dendl²  Katharina Ehehalt¹  Felix C Popp⁴  Christina Hackl⁴ 

[1]Department of Anaesthesia, University Medical Center Regensburg, Regensburg, Germany

[2]Department of Radiology, University Medical Center Regensburg, Regensburg, Germany

[3]Department of Trauma, Plastic and Hand Surgery, University Medical Center Regensburg, Regensburg, Germany

[4]Department of Surgery, University Medical Center Regensburg, Regensburg 93042, Germany

[5]Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg, Germany

关键词: Esophageal reconstruction;    Conduit;    Esophageal cancer;    Gastric pull-up;   

Others  :  1091733
DOI  :  10.1186/1471-2482-14-78

 received in 2013-08-04, accepted in 2014-10-08,  发布年份 2014

【 摘 要 】

Background

Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system.

Case presentation

A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion.

Conclusions

This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy.

【 授权许可】

   
2014 Hackl et al.; licensee BioMed Central Ltd.

【 图 表 】

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