J.Jpn. Surg. Soc.. 80(11): 1168-1171, 1979

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Report on the annual meeting

THE ANTE-THORACIC ESOPHAGOGASTROSTOMY, ANASTOMOSIS BETWEEN THE STUMP OF THE ESOPHAGUS AND THE POSTERIOR WALL OF THE STOMACH

There are three possible routes for esophagoplasty after resection of the thoracic esophageal cancer, such as ante-thoracic subcutaneous, retrosternal and intrathoracic routes. In our series of 741 operated patients, the ante-thoracic esophagogastrostomy has been carried out in 70%. The operative mortality rate was 4.3%.
Some advantages in the ante-thoracic subcutaneous esophagogastrostomy are listed as follows:
(1) less fatal suture insufficiency, (2) easy re-opening of the gastrostomy of the elevated stomach for tube feeding in case oral ingestion becomes difficult, and so on. However a disadvantage is remembered as occasional occurrence of suture insufficiency at the anastomotic site.
Some modifications have been carried out to prevent the suture insufficiency. The large stomach tube is made, for this purpose the right gastric vessels must be preserved. The circumferential incisions of the serosa and the muscular layer of the stomach are carried out if the stomach does not extend sufficiently. The anastomosis in the neck is made between the stump of the esophagus and the posterior wall of the stomach. The suture is with layer to layer in two lines. In this anastomosis, the unequal tension is not seen at the anastomotic stoma. The anastomotic site is covered with the top of the stomach tube to keep the adequate temperature and to avoid the direct contact to the skin.
With this method, the incidence of 39% of major leakage by the conventional method could be decreased to only 3％ of major leakage and 8% of minor leakage.

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