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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-10-15

AUTHORS

Christina Hackl, Felix C Popp, Katharina Ehehalt, Lena-Marie Dendl, Volker Benseler, Philipp Renner, Martin Loss, Jurgen Dolderer, Lukas Prantl, Thomas Kühnel, Hans J Schlitt, Marc H Dahlke

ABSTRACT

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. More... »

PAGES

78-78

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1471-2482-14-78

DOI

http://dx.doi.org/10.1186/1471-2482-14-78

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1037416405

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25319372


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