论文部分内容阅读
I ntroductionThe standard reconstruction after esophagectomy is the formation of a gastric tube with cervical or intrathoracic esophagogastrostomy.This type of reconstruction is associated with a considerable morbiditv and mortality due to anastomotic leakage of the esophagogastrostomy[4,5,23].Although several etiological factors have been discussed to contribute to this clinicallv relevant complication ischemia is considered to be the most important one[9].It is evident that the formation of a gastric tube with mobilization ofthe stomach,ligation of the left gastric artery and short gastric arteries,resection of the lesser curvature and gastric pull-up induces microcirculatory changes in the anastomotic region of the gastric fundus.Following formation of the gastric tube the vascularization of the anastomotic region relies only on the right gastroepiploic artery,the right gastric artery and the intramural capillary plexus.Despite this induction of ischemiathe partial devascularization ofthelesser curvature is a necessary surgical preparation in order to perform the pull up ofthe gastric conduit.