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Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report

BACKGROUND: Anastomotic stenosis can occur after esophagectomy and gastric tube reconstruction. The effective surgical treatment for refractory anastomotic stenosis, which seems difficult to resolve with endoscopic treatment, has not been established. We report a case of refractory stenosis due to e...

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Autores principales: Yamaguchi, Kazuya, Haruki, Shigeo, Sakano, Masayoshi, Suzuki, Kunihito, Miura, Akinori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068859/
https://www.ncbi.nlm.nih.gov/pubmed/35507011
http://dx.doi.org/10.1186/s40792-022-01430-9
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author Yamaguchi, Kazuya
Haruki, Shigeo
Sakano, Masayoshi
Suzuki, Kunihito
Miura, Akinori
author_facet Yamaguchi, Kazuya
Haruki, Shigeo
Sakano, Masayoshi
Suzuki, Kunihito
Miura, Akinori
author_sort Yamaguchi, Kazuya
collection PubMed
description BACKGROUND: Anastomotic stenosis can occur after esophagectomy and gastric tube reconstruction. The effective surgical treatment for refractory anastomotic stenosis, which seems difficult to resolve with endoscopic treatment, has not been established. We report a case of refractory stenosis due to esophageal torsion in which reconstructive surgery was possible using a left thoracoscopic approach in the supine position. CASE PRESENTATION: A 72-year-old man who underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer 6 months previously presented to us. Postoperative endoscopy revealed that the residual esophagus was twisted approximately 360°, just above the anastomotic site. Conservative endoscopic treatment failed to improve the condition due to severe passage obstruction, and reconstructive surgery was repeated. Surgery was performed in the supine position using a left thoracoscopic approach. The entire circumferences of the gastric tube and residual esophagus were dissected from the inferior mediastinum to the top of the sternum, with focus on preserving the right gastroepiploic vein and gastric-tube wall. Subsequently, laparoscopic surgery was performed to remove the gastric tube from the thoracoabdominal junction. After separating the esophagus on the oral side of the torsion from the left cervical wound, the abdomen was opened, the gastric tube was pulled out through the abdominal wound, and adhesions in the abdominal cavity were peeled off to raise the gastric tube cranially via the retrosternal route. An end-to-side anastomosis was performed using a circular stapler, and the esophageal torsion and previous anastomosis were resected. Oral intake was resumed on the 7th postoperative day, and the patient was discharged on the 38th day. CONCLUSIONS: After subtotal esophagectomy and retrosternal gastric tube reconstruction, the left thoracoscopic approach is one of the most minimally invasive approaches and is especially useful for preserving the right gastroepiploic artery and veins and for mobilizing the gastric tube wall.
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spelling pubmed-90688592022-05-07 Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report Yamaguchi, Kazuya Haruki, Shigeo Sakano, Masayoshi Suzuki, Kunihito Miura, Akinori Surg Case Rep Case Report BACKGROUND: Anastomotic stenosis can occur after esophagectomy and gastric tube reconstruction. The effective surgical treatment for refractory anastomotic stenosis, which seems difficult to resolve with endoscopic treatment, has not been established. We report a case of refractory stenosis due to esophageal torsion in which reconstructive surgery was possible using a left thoracoscopic approach in the supine position. CASE PRESENTATION: A 72-year-old man who underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer 6 months previously presented to us. Postoperative endoscopy revealed that the residual esophagus was twisted approximately 360°, just above the anastomotic site. Conservative endoscopic treatment failed to improve the condition due to severe passage obstruction, and reconstructive surgery was repeated. Surgery was performed in the supine position using a left thoracoscopic approach. The entire circumferences of the gastric tube and residual esophagus were dissected from the inferior mediastinum to the top of the sternum, with focus on preserving the right gastroepiploic vein and gastric-tube wall. Subsequently, laparoscopic surgery was performed to remove the gastric tube from the thoracoabdominal junction. After separating the esophagus on the oral side of the torsion from the left cervical wound, the abdomen was opened, the gastric tube was pulled out through the abdominal wound, and adhesions in the abdominal cavity were peeled off to raise the gastric tube cranially via the retrosternal route. An end-to-side anastomosis was performed using a circular stapler, and the esophageal torsion and previous anastomosis were resected. Oral intake was resumed on the 7th postoperative day, and the patient was discharged on the 38th day. CONCLUSIONS: After subtotal esophagectomy and retrosternal gastric tube reconstruction, the left thoracoscopic approach is one of the most minimally invasive approaches and is especially useful for preserving the right gastroepiploic artery and veins and for mobilizing the gastric tube wall. Springer Berlin Heidelberg 2022-05-04 /pmc/articles/PMC9068859/ /pubmed/35507011 http://dx.doi.org/10.1186/s40792-022-01430-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Yamaguchi, Kazuya
Haruki, Shigeo
Sakano, Masayoshi
Suzuki, Kunihito
Miura, Akinori
Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title_full Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title_fullStr Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title_full_unstemmed Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title_short Left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
title_sort left thoracoscopic approach in the supine position for torsion of the residual esophagus after esophagectomy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068859/
https://www.ncbi.nlm.nih.gov/pubmed/35507011
http://dx.doi.org/10.1186/s40792-022-01430-9
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