J.Jpn. Surg. Soc.. 79(9): 1222-1227, 1978

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Report on the annual meeting

OPERATION FOR CARCINOMA OF THE LOWER ESOPHAGUS AND CARDIA

Previously we verified that the largest factor for the long-term dysfunction of the Kirschner-Nakayama type of gastric tube for esophageal reconstruction would resulted from bilateral truncal vagotomy at the thoracic esophagectomy and the esophageal reconstruction with this type of the gastric tube. We invented a new operative procedure, intrathoracic esophagogastrostomy with additional vagal implantation into the wall of the gastric tube.
At first, the stomach is mobilized preserving the right gastric and the right gastroepiploic vessels and the Kirschner-Nakayama type of gastric tube is constructed through an upper median laparotomy incision in the supine position. Then the intrathoracic end-to-side esophagogastrostomy is performed and the isolated vagal trunks are implanted into the anterior muscular layer of the gastric tube through a standard anterolateral thoracotomy incision in the sixth intercostal space in the right recumbent position.
Hitherto, 37 cases of carcinoma of the lower esophagus and cardia and one case of carcinoma of the mid-thoracic esophagus have undergone this new method of operation. This additional vagal implantation into the gastric tube has been proved to contribute to the restoration of the secretory and motorial functions of the gastric tube in long-term follow-up.

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