Waseem Talat, Azim Asad, Ashraf Muhammad Hasham, Azim Khawaja M
Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Punjab 54000, Pakistan.
World J Gastrointest Surg. 2016 Dec 27;8(12):766-769. doi: 10.4240/wjgs.v8.i12.766.
Select group of patients with concurrent esophageal and gastric stricturing secondary to corrosive intake requires colonic or free jejunal transfer. These technically demanding reconstructions are associated with significant complications and have up to 18% ischemic conduit necrosis. Following corrosive intake, up to 30% of such patients have stricturing at the pyloro-duodenal canal area only and rest of the stomach is available for rather less complex and better perfused gastrointestinal reconstruction. Here we describe an alternative technique where we utilize stomach following distal gastric resection along with Roux-en-Y reconstruction instead of colonic or jejunal interposition. This neo-conduit is potentially superior in terms of perfusion, lower risk of gastro-esophageal anastomotic leakage and technical ease as opposed to colonic and jejunal counterparts. We have utilized the said technique in three patients with acceptable postoperative outcome. In addition this technique offers a feasible reconstruction plan in patients where colon is not available for reconstruction due to concomitant pathology. Utility of this technique may also merit consideration for gastroesophageal junction tumors.
因摄入腐蚀性物质继发食管和胃同时狭窄的患者群体，需要进行结肠或游离空肠移植。这些技术要求高的重建手术会伴随严重并发症，且有高达18%的缺血性管道坏死发生率。摄入腐蚀性物质后，高达30%的此类患者仅在幽门十二指肠管区域出现狭窄，胃的其余部分可用于相对不那么复杂且血供更好的胃肠道重建。在此，我们描述一种替代技术，即在远端胃切除术后利用胃并进行Roux-en-Y重建，而非结肠或空肠置入。与结肠和空肠相比，这种新管道在灌注方面可能更具优势，胃食管吻合口漏的风险更低，技术操作也更简便。我们已将该技术应用于3例患者，术后结果可接受。此外，对于因合并其他病变而无法用结肠进行重建的患者，该技术提供了一个可行的重建方案。对于胃食管交界肿瘤，该技术的实用性也值得考虑。
