Gastric remnant reconstruction with left gastroepiploic artery supercharge after esophagectomy in a patient with an occluded right gastroepiploic artery: A technical and case report.

INTRODUCTION

Gastric remnant reconstruction is commonly used for esophagectomy reconstruction. However, standard reconstruction cannot be performed in some patients with a specific medical history. We report a case of esophagectomy and gastric remnant reconstruction with left gastroepiploic artery (LGEA) supercharge to treat esophageal cancer in a patient in whom the right gastroepiploic artery (RGEA) had previously been occluded.

PRESENTATION OF CASE

A 65-year-old man underwent endoscopic submucosal dissection for thoracic esophageal squamous cell carcinoma. He was diagnosed with pathological T1b cancer with lymphatic invasion and a positive horizontal margin, and needed curative resection. He had previously undergone RGEA embolization to treat a pseudoaneurysm caused by chronic pancreatitis. We successfully performed esophagectomy and gastric remnant reconstruction with preoperative left gastric artery embolization and intraoperative LGEA supercharge.

DISCUSSION

An absent RGEA blood supply is not always a contraindication for gastric remnant reconstruction when the collateral blood flows are well developed and supercharge can maintain the blood supply to the gastric remnant.

CONCLUSIONS

Gastric remnant reconstruction with preoperative selective arterial embolization and intraoperative supercharge represents one of the options for high-risk patients with an altered gastric blood supply.