Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.766
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
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.
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.