J.Jpn. Surg. Soc.. 83(9): 878-881, 1982

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Report on the annual meeting

COUNTERMEASURES AGAINST ANASTOMOTIC DISRUPTION AT THE ANTETHORACIC ESOPHAGOGASTROSTOMIC REGION AFTER RESECTION OF CANCER OF THE UPPER TWO-THIRDS OF THORACIC ESOPHAGUS

It is considered that the most significant causes of suture disruption at the antethoracic esophagogastrostomic region are the circulatory disturbance in the gastric tube and the tension imposed on the suture line. Experimental study was performed to clarify the mechanism of this blood circulatory disturbance in the Kirschner-Nakayama type of gastric tube. It was revealed that vagotomy is the most important cause of this circulatory disturbance among several factors and the decrease of blood flow and the opening of submucosal arteriovenous anastomosis are induced by vagotomy. The right thoracic sympathectomy (Th5-10) had remarkable effect on this impaired blood circulation. Recently, we apply this thoracic sympathectomy to clinical cases as a countermeasure against suture disruption including our usual procedures as we asserted. The rate of primary healing of antethoracic esophagogastrostomy is 74.2% and the rate of successful anastomosis is 92.4% with great improvement for the past five and a half years.

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