Therapeutic Advances
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2016; 8(12): 766-769
Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.766
Roux-en-Y augmented gastric advancement: An alternative technique for concurrent esophageal and pyloric stenosis secondary to corrosive intake
Talat Waseem, Asad Azim, Muhammad Hasham Ashraf, Khawaja M Azim
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
Author contributions: Waseem T and Azim KM contributed to the development of the technique and critical review of the article; Azim A and Ashraf MH contributed to the manuscript writing; all the authors contributed to the paper.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Talat Waseem, Assistant Professor of Surgery, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Punjab 54000, Pakistan. twaseem@gmail.com
Telephone: +92-333-8078705 Fax: +92-423-6835555
Received: May 15, 2016
Peer-review started: May 17, 2016
First decision: July 11, 2016
Revised: August 10, 2016
Accepted: October 1, 2016
Article in press: October 9, 2016
Published online: December 27, 2016
Processing time: 219 Days and 0.8 Hours
Abstract

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.

Keywords: Corrosive strictures; Roux-en-Y augmented gastric advancement; Colonic interposition

Core tip: Selected patients with concurrent esophageal and gastric stricturing secondary to corrosive intake require colonic or free jejunal transfer. These technically demanding reconstructions are associated with significant conduit necrosis. An alternative technique we utilize stomach with Roux-en-Y reconstruction instead of colonic or jejunal interposition has been presented.