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Surgical Endoscopy

, Volume 26, Issue 1, pp 271–276 | Cite as

Surgical optimisation of the gastric conduit for minimally invasive oesophagectomy

  • Shahjehan A. WajedEmail author
  • Darmarajah Veeramootoo
  • Angela C. Shore
Video

Abstract

Background

Total minimally invasive oesophagectomy (MIO) is a valid alternative to open surgery for the management of oesophagogastric cancer and may lead to a more rapid restoration of health-related quality of life post surgery. However, a high incidence of gastric conduit failure (GCF) has also been observed which could be detrimental to any potential benefits of this approach. Technical modifications have been introduced in an attempt to reduce conduit morbidity, and the aim of this study was to evaluate their efficacy.

Methods

Minimally invasive oesophagectomy has been the procedure of choice in our unit since April 2004. Data on patient and surgical variables are entered onto a prospective database. Laparoscopic ischaemic conditioning (LIC) by ligation of the left gastric vessels 2 weeks prior to MIO was introduced in April 2006. Extracorporeal formation of the gastric conduit through a minilaparotomy was offered to patients since January 2008. Where present, GCF was characterised as one of three types: I, simple anastomotic leak; II, conduit tip necrosis; and III, whole conduit necrosis.

Results

As of January 2010, 131 patients had undergone an MIO and GCF was observed in 21 patients (16.0%). Sixty-seven patients had LIC and 9 of them (13.4%) developed GCF (I, 10.4%; II, 0%; III, 3.0%) compared to 12 (18.8%) of 64 patients who did not have LIC (I, 6.3%; II, 7.8%; III, 4.7%). A total of 43 patients had an extracorporeally fashioned conduit and 6 (14.0%) developed GCF (I, 11.6%; II, 0%; III, 2.3%), whilst 88 had an intracorporeal conduit with 15 (17.0%) developing GCF (I, 6.8%; II, 5.7%; III, 4.5%). GCF can be reduced with the incorporation of LIC and an extracorporeally fashioned conduit, with possible elimination of type II conduit tip necrosis.

Conclusions

Surgical modification of a three-stage minimally invasive oesophagectomy technique, with the further incorporation of laparoscopic ischaemic conditioning and extracorporeal conduit formation, reduces gastric conduit morbidity, allowing the potential benefits of this approach to be realised.

Keywords

Oesophagectomy Minimally invasive Optimisation Gastric conduit 

Notes

 

Disclosure

Darmarajah Veeramootoo, Angela C. Shore, and Shahjehan A. Wajed have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 107123 kb)

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Shahjehan A. Wajed
    • 1
    Email author
  • Darmarajah Veeramootoo
    • 1
    • 2
  • Angela C. Shore
    • 2
  1. 1.Department of Upper Gastro-Intestinal SurgeryExeter Oesophago-Gastric Centre, Royal Devon and Exeter NHS Foundation TrustExeterUK
  2. 2.Institute of Biomedical and Clinical SciencePeninsula College of Medicine and Dentistry, University of ExeterExeterUK

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