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J Thorac Dis. 2019 Apr;11:S743-S749. doi: 10.21037/jtd.2019.01.28.

Optimal mobilization of the stomach and the best place in the gastric tube for intrathoracic anastomosis.

Journal of thoracic disease

Wytze Laméris, Wietse J Eshuis, Miguel A Cuesta, Suzanne S Gisbertz, Mark I van Berge Henegouwen


  1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.

PMID: 31080653 PMCID: PMC6503276 DOI: 10.21037/jtd.2019.01.28


Esophagectomy with gastric tube reconstruction is a highly complex surgical procedure. With regard to mobilization of the stomach and optimal gastric tube preparation and anastomosis, there are several important intraoperative steps that can influence the outcome of the operation. This study aims to describe the optimal mobilization of the stomach for gastric tube reconstruction and explore the best place in the gastric tube for intrathoracic anastomosis after esophagectomy. A search of the literature was performed and results are described in a descriptive review. Based on literature and our own experience we describe important operating steps for laparoscopic stomach mobilisation for gastric tube reconstruction. Steps to create additional length include preserving the left gastroepiploic artery, transecting the right gastric artery, extended duodenal mobilization, and duodenal diversion with roux-Y reconstruction. Several techniques for intrathoracic anastomosis are described in literature. Several imaging techniques, of which fluorescence imaging is the most commonly used, are available to assess the vascularization of the gastric tube and to assist in determining the best place in the gastric tube for intra thoracic anastomosis. Although there is little evidence of exact technique on stomach mobilization and location for an intrathoracic anastomosis, many techniques are used by different authors with varying results.

Keywords: Esophagectomy; gastric tube; intrathoracic anastomosis

Conflict of interest statement

Conflicts of Interest: MI van Berge Henegouwen—Educational grant Stryker, Research grant Olympus, Consultant for Medtronic; SS Gisbertz—Research grant Olympus, Consultant for Medtronic. The other auth


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