How Important Is the Route of Reconstruction After Esophagectomy: A Prospective Randomized Study

Gawad, K. A.; Hosch, S. B.; Bumann, D.; Lübeck, M.; Moneke, L. C.; Bloechle, C.; Knoefel, W. T.; Busch, C.; Küchler, Th.; Izbicki, J. R.
June 1999
American Journal of Gastroenterology;Jun1999, Vol. 94 Issue 6, p1490
Academic Journal
OBJECTIVE: A prospective randomized trial was performed to compare retrosternal and posterior mediastinal gastric tube reconstruction with regard to postoperative function and quality of life. METHODS: Twenty-six patients were randomly allocated to either retrosternal (n = 14) or posterior mediastinal (n = 12) reconstruction after gastric tube formation. Radionuclide transit studies were applied to obtain objective functional data and a standardized quality-of-life assessment was performed. RESULTS: Retrosternal reconstruction showed an increased morbidity (15 vs 13 major complications) and mortality (14.2 vs 8.3%). Radionuclide clearance in the supine position was delayed in the gastric tube in general, compared with normal controls (retention index > 40% vs < 10%). There was a significantly higher retention (p < 0.005) in the retrosternal group in the middle third of the tube and the whole tube after intake of the liquid tracer. The retention of the first solid tracer was also higher in the retrosternal group in the middle third of the tube (p = n.s.) and was significantly higher in the whole tube after 30 (p < 0.05) and 60 (p < 0.01) s. This had no significant impact on the patients' quality of life. CONCLUSIONS: The posterior mediastinal route of reconstruction is recommended but curative resection (R0) is mandatory to avoid possible complications due to local tumor relapse. After incomplete resection (R1 or R2) we recommend retrosternal reconstruction for better palliation.


Related Articles

  • Postbariatrische plastische Chirurgie. Altintas, M.A.; Vogt, P.M. // Der Chirurg;Jun2013, Vol. 84 Issue 6, p527 

    Postbariatric plastic surgery after major weight loss can improve quality of life through functional reconstruction and restoration of a normal body contour. Comorbidities associated with obesity necessitate individual indications and precise preoperative planning in order to reduce the rate of...

  • Transumbilical single-incision laparoscopic sleeve gastrectomy: Short-term results and technical considerations. Mittermair, Reinhard // Journal of Minimal Access Surgery;Jul-Sep2013, Vol. 9 Issue 3, p104 

    BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has gained popularity and acceptance among bariatric surgeons, mainly due its low morbidity and mortality. Single-incision laparoscopic surgery has emerged as another modality of carrying out the bariatric procedures. While the single-incision...

  • Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis. Kitagami, Hidehiko; Morimoto, Mamoru; Nozawa, Masashi; Nakamura, Kenichi; Tanimura, Shinya; Murakawa, Katsuhiko; Murakami, Yoshihiro; Kikuchi, Kenji; Ushigome, Hajime; Sato, Leo; Yamamoto, Minoru; Shimizu, Yasunobu; Hayakawa, Tetsushi; Tanaka, Moritsugu; Hirano, Satoshi // Surgical Endoscopy;Jul2014, Vol. 28 Issue 7, p2137 

    Background: Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and published, whereas only a limited number of reports are available on the utility of the delta-shaped anastomosis (Delta). This study compared Delta and Roux-en-Y anastomoses (RY),...

  • Counterpoint: Cosmetic Surgery is a Dangerous and Costly Trend. Sexton, Jennifer; Carson-Dewitt, Rosalyn // Points of View: Cosmetic Surgery;3/1/2016, p3 

    The article criticizes the use of cosmetic surgery as a way of dealing with low self-esteem, dissatisfaction with one's physical appearance and poor quality of life. It is asserted that people have become obsessed with appearance, as shown by their use of cosmetic surgery despite its high cost...

  • How I Manage Complications in Aesthetic Surgery. Vedamurthy, Maya // Journal of Cutaneous & Aesthetic Surgery;Jun2015, Vol. 8 Issue 2, p106 

    A personal narrative is presented which explores the author's experience of helping patients manage their aesthetic surgery complications, keeping them calm, and scheduling for appointments.

  • Quality of life of patients after bariatric treatment - preliminary report. Sierżantowicz, R.; Hady, R. H.; Kirpsza, B.; Trochimowicz, L.; Dadan, J. // Progress in Health Sciences;2012, Vol. 2 Issue 1, p89 

    Introduction: Obesity afflicts approximately 3,000,000 people in Poland. Co-morbidities develop mainly in connection with morbid obesity. Bad health conditions connected with obesity may decrease the health-related quality of life (HRQOL). A body mass index of 30-34 kg/m2, along with...

  • Evaluation of QOL After Proximal Gastrectomy Using a Newly Developed Assessment Scale (PGSAS-45). Inada, Takao; Yoshida, Masashi; Ikeda, Masami; Yumiba, Takeyoshi; Matsumoto, Hideo; Takagane, Akinori; Kunisaki, Chikara; Fukushima, Ryoji; Yabusaki, Hiroshi; Nakada, Koji // World Journal of Surgery;Dec2014, Vol. 38 Issue 12, p3152 

    Background: Proximal gastrectomy with esophagogastrostomy (PGEG) has been widely applied as a comparatively simple method. In this study, we used a questionnaire survey to evaluate the influence of various surgical factors on post-operative quality of life (QOL) after PGEG. Methods: In this...

  • The morality of surgery for aesthetic purposes in accordance with principlist bioethics. Gracindo, Giselle Crosara Lettieri // Revista Bioetica;2015, Vol. 23 Issue 3, p522 

    The cult of beauty emerged in the West with the goddess Aphrodite, and reigns today in social media, driven by the worship of celebrities' images. The "fever" of selfies fuels the desire to change. In 2013, Brazil led the world ranking of plastic surgery, overtaking the United States, according...

  • Adenocarcinoma arising in a colonic interposition following a total gastrectomy: Report of a case. Yoshiyuki Kuwabara; Masahiro Kimura; Akira Mitsui; Hideaki Ishiguro; Keisuke Tomoda; Yoichiro Mori; Ryo Ogawa; Koshiro Harata; Takeyasu Katada; Yoshitaka Fujii // Surgery Today;Sep2009, Vol. 39 Issue 9, p800 

    Abstract  A segment of the transverse colon can be used for gastric reconstruction after a total gastrectomy. This report presents the case of a 68-year-old woman with primary adenocarcinoma of the colon in a segment used for reconstruction after a total gastrectomy. The interposed colon...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics