Skip to main content

Advertisement

SpringerLink
Log in

Microvascular reconstruction in salvaging the gastric conduit post-esophagectomy after iatrogenic right gastroepiploic vessel injury

  • Case report
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

The preservation of the right gastroepiploic vessels is essential to ensure proper perfusion of the gastric conduit following esophagectomy. The loss of these vessels can lead to conduit ischemia or necrosis, resulting in significant postoperative complications. Traditional approaches such as colonic or jejunal interposition require extensive surgery and multiple anastomoses. In this report, we present our successful experience of salvaging the gastric tube through microvascular reconstruction following iatrogenic injury to the right gastroepiploic vessels in two cases. The first case involved re-anastomosis of the right gastroepiploic vein, while the second case required reconstruction of both the artery and vein during esophagectomy in a single setting. The procedures were performed by an experienced surgical team using microvascular techniques. Both patients had uneventful postoperative courses without any anastomotic leakage or major complications. Adequate perfusion of the salvaged gastric tube was confirmed intraoperatively using indocyanine green fluorescence perfusion imaging. In conclusion, immediate microvascular reconstruction offers a viable solution by restoring perfusion of the gastric tube in cases of right gastroepiploic vessel injury during esophagectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits. Surg Clin North Am. 2012;92:1287–97.

    Article  PubMed  Google Scholar 

  2. Dickinson KJ, Blackmon SH. Management of conduit necrosis following esophagectomy. Thorac Surg Clin. 2015;25:461–70.

    Article  PubMed  Google Scholar 

  3. Kono K, Sugai H, Omata H, Fujii H. Transient bloodletting of the short gastric vein in the reconstructed gastric tube improves gastric microcirculation during esophagectomy. World J Surg. 2007;31:780-4; discussion:785–6.

    Article  Google Scholar 

  4. Athanasiou A, Hennessy M, Spartalis E, Tan BHL, Griffiths EA. Conduit necrosis following esophagectomy: an up-to-date literature review. World J Gastrointest Surg. 2019;11:155–68.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bakshi A, Sugarbaker DJ, Burt BM. Alternative conduits for esophageal replacement. Ann Cardiothorac Surg. 2017;6:137–43.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Colon MJ, Sanjeevi S, Flores R, Reddy R. Transection of the right gastroepiploic artery does not exclude a gastric conduit in Ivor-Lewis esophagectomy. Ann Thorac Surg. 2016;101:333–4.

    Article  PubMed  Google Scholar 

  7. Kitagawa H, Namikawa T, Iwabu J, Hanazaki K. Gastric tube reconstruction with superdrainage using indocyanine green fluorescence during esophagectomy. Vivo Athens Greece. 2017;31:1019–21.

    Google Scholar 

  8. van Boxel GI, Kingma BF, de Maat MFG, Voskens F, Schellekens PPA, van Hillegersberg R. Single-admission, staged restoration of gastrointestinal continuity after right gastroepiploic artery damage. Ann Thorac Surg. 2020;109:e259–61.

    Article  PubMed  Google Scholar 

  9. Chen L, Zhang J, Chen D, Sang Y, Yang W. Simultaneous vascular reconstruction and cervical anastomosis in McKeown esophagectomy. Front Surg. 2021;8:646811.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ramage L, Deguara J, Davies A, Hamouda A, Tsigritis K, Forshaw M, et al. Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue. Ann R Coll Surg Engl. 2013;95:329–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Choudhary S, Khanna S, Mantri R, Arora P. Role of indocyanine green angiography in free flap surgery: a comparative outcome analysis of a single-center large series of 877 consecutive free flaps. Indian J Plast Surg. 2023;56:208–17.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

    Rajesh Yellinedi & Rambabu Nuvvula

  2. Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, 500034, India

    Madhunarayana Basude, Kalidindi Vijaya Venkata Narsimha Raju & Syed Nusrath

  3. Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia

    Yogesh Vashisht

Authors
  1. Rajesh Yellinedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rambabu Nuvvula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madhunarayana Basude
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kalidindi Vijaya Venkata Narsimha Raju
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yogesh Vashisht
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Syed Nusrath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Syed Nusrath.

Ethics declarations

Ethics approval and consent to participate

All patient information included in this report has been de-identified to protect the individuals’ identities. No personally identifiable information, such as names, initials, or specific demographic details, has been included in the report. The study protocol was reviewed and approved by the institutional ethical committee to ensure compliance with ethical guidelines and patient privacy regulations. Informed consent was not obtained from individual patients, as this study utilized pre-existing medical records and did not involve any additional interventions or interactions with patients.

Competing interests

The authors declare no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yellinedi, R., Nuvvula, R., Basude, M. et al. Microvascular reconstruction in salvaging the gastric conduit post-esophagectomy after iatrogenic right gastroepiploic vessel injury. Indian J Thorac Cardiovasc Surg 40, 238–241 (2024). https://doi.org/10.1007/s12055-023-01633-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-023-01633-1

Keywords

Search

Navigation