Managing an Unusual Case of a Long Segment Benign Esophageal Stricture
Wickii T. Vigneswaran in Thoracic Surgery, 2019
Then, the patient was placed supine, and an upper abdominal laparoscopy was performed. Upon entrance into the abdomen, it was noted that the loop of jejunum pexied to the anterior abdominal wall consistent with a previous feeding jejunostomy. The stomach was mobilized on the gastroepiploic artery. It appeared healthy and distensible and would be a viable source for conduit. The duodenum was then Kocherized completely. After dividing the left gastric artery and vein, the gastric conduit was created with six fires of the Endo GIA. Then two additional tacking sutures were placed to the portion of small bowel that was attached to the anterior abdominal wall. After verifying proximal and distal orientation of the bowel, an enterotomy was then made, the 16-French Malecot tube was introduced into the lumen, and the feeding tube was established. Simultaneously, a left cervical incision was made, and the proximal esophagus was delivered into the neck. The distal esophagus was then attached to the Foley catheter and then delivered through the mediastinum into the neck. A near total esophagectomy was completed. Then the gastric conduit was brought into the neck. Esophagogastrostomy was then fashioned and the liner stapled posterior anastomosis completing anterior anastomosis with interrupted (4-0 polydioxanone PDS) sutures [2,3]. The neck wound was then closed in layers as well as the abdominal port sites.
Colectomy - Complete Mesocolic Excision
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The technical steps for resecting a colon cancer at the hepatic flexure begin as for resecting ascending colon cancer. However, the middle colic arteries are ligated centrally, finally leading to so-called extended right hemicolectomy. Moreover, the greater curvature of the distal gastric antrum is skeletonized. Then the dissection plane follows along the superior pancreaticoduodenal vessels which show many variations. The right gastroepiploic artery is divided, followed by the corresponding vein. Simultaneously, the infrapyloric nodes and those over the head and below the isthmus of the pancreas are included into the specimen with preservation of the mesopancreas covering the head and the uncinate process. As described, the right-sided greater omentum is divided with preservation of the left part, which is dissected off the middle and left transverse colon. The colon itself is divided about 10 cm distal to the root of the middle colic vessels.
Diagnostic angiographic catheters: Coronary and vascular
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Uncommonly, the right gastroepiploic artery might be used as a bypass graft to the posterior descending artery. [3]The right gastroepiploic artery originates as a branch of the gastroduodenal artery, which is a branch of the common hepatic artery from the celiac trunk. Selective engagement of the celiac trunk will provide “nonselective” angiography of the right gastroduodenal artery. The celiac trunk origi- nates from the anterior aorta just below the diaphragm at the level of the T12 vertebral body. Lateral angiography provides the best views of the takeoff of the celiac trunk to allow for selective engagement with a JR4 or internal mam- mary artery catheter. When those catheters will not selec- tively engage the celiac trunk, then visceral catheters such as the Cobra or SOS catheters (see section entitled Peripheral Diagnostic Catheters) can be used. If poor visualization of the distal graft anatomy and runoff is seen with nonselec- tive angiography, then super-selective angiography must be performed. This requires using an exchange length angled Terumo Glidewire to advance selectively into the right gas- troepiploic (Figure 17.9). The supporting diagnostic cath- eter can then be exchanged for a 4-Fr soft Glide Catheter (Terumo) that is small and soft enough to be positioned deep into the right gastroepiploic without causing any trauma. Its 4-Fr size will allow for adequate angiography when it is selectively engaged.
Is Preoperative G-Tube Use Safe for Esophageal Cancer Patients?
Published in Journal of the American College of Nutrition, 2020
Sabrina M. Saeed, Jacques P. Fontaine, Aamir N. Dam, Sarah E. Hoffe, Miles Cameron, Jessica Frakes, Rutika Mehta, Erin Gurd, Jose M. Pimiento
The 2018 NCCN guidelines suggest that g-tube placement should be avoided prior to esophagogastrectomy due to the risk of injuring the gastric conduit used for reconstruction. Case reports and small retrospective studies have reported injury to the gastric vasculature caused by prior g-tube placement. Stockeld et al. reported on a case where the gastroepiploic artery was damaged, but adequate blood supply was maintained allowing for use of the gastric conduit (28). In another case reported by Ohnmacht et al., damage to the gastric vasculature resulted in abortion of the procedure (21). In our study, there were no cases documenting damage to the gastric vasculature, and the gastric conduit was used in all patients. The majority of g-tubes were placed by interventional radiologists at Moffitt Cancer Center under the direction of the primary surgeon. Some patients received g-tubes through various methods of placement at outside institutions without prior direction by the Moffitt treatment team. We feel that the risk of gastric vasculature injury, already low, can be further reduced if there is adequate communication between the gastroenterologist and surgeon regarding the approach and location of g-tube placement. The gastroenterologist may therefore take better care to avoid the greater curvature and preserve the gastric blood supply.
Tissue Oxygen Saturation during Gastric Tube Reconstruction with Cervical Anastomosis for Esophagectomy: A Case Series
Published in Journal of Investigative Surgery, 2022
Kenjiro Ishii,, Yasuhiro Tsubosa,, Shuhei Mayanagi,, Masazumi Inoue,, Ryoma Haneda,
In terms of blood supply to the gastric tube, the right gastroepiploic artery is the exclusive conduit of blood to the pedicle and the blood supply of the cranial 20% of the greater curvature of the stomach is supplied by a microscopic network of capillaries and arterioles [19]. Therefore, it is conceivable that the blood flow to the cranial side of the gastric tube gradually decreases toward the tip as it is raised to the cervical site.
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
In conventional colon resection, the GEOM region is divided at the relatively avascular attachment to the colon or between the gastroepiploic vessels and the colon. We divided the branches to the stomach from the gastroepiploic artery and vein. Using this procedure, we were able to include the lymph nodes along these vessels in the specimen.
Related Knowledge Centers
- Abdominal Wall
- Lesser Omentum
- Peritoneum
- Transverse Colon
- Small Intestine
- Liver
- Stomach
- Pelvis
- Curvatures of The Stomach
- Duodenum