V-22. Gastric Conduit-Esophagus Cervical Anastamosis-Anterior Layer Reinforcement-a Novel Innovative Technique
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ID: 325681
2026
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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Cervical esophagogastric anastomosis after esophagectomy is associated with significant rates of anastomotic leak and stricture, largely due to tension, size mismatch, and compromised perfusion at the anastomotic site. Various technical modifications have been described to improve outcomes, yet anastomotic complications remain clinically relevant. We describe a novel technique of anterior layer widening of the gastric conduit to optimize luminal diameter, reduce tension, and improve mucosal apposition during cervical esophagogastric anastomosis Methods Following standard esophagectomy and vascularised gastric conduit preparation,the gastric conduit is brought into neck without any tension. The posterior wall of the gastric conduit is longitudinally widened at the intended anastomotic site. posterior layer anastamosis of esophagus and gastric conduit done in interrupted fashion.60mm linear stapler is fired vertically to complete posterior layer.blind pouch of tip of conduit is cut horizontally to widen the anterior layer of anastamosis. Part of anterior layer of gastric conduit now forms the part of anterior layer from esophagus side and corners are rearranged. This modification creates a broader anastomotic surface along anterior layer and allows tailoring of the conduit opening to match the esophageal lumen. A hand-sewn, single layer end-to-end cervical esophagogastric anastomosis is then performed, with special attention to mucosal alignment and tension-free approximation. Results The anterior layer widening technique was technically feasible and reproducible. The widened conduit opening facilitated tension-free anastomosis and improved luminal matching between the esophagus and gastric conduit. This technique has a potential to decrease stricture rates in the long run because of anastamotic diameter reaching upto 5cm anteriorly. Conclusion Anterior layer widening of the gastric conduit represents a simple, reproducible modification for cervical esophagogastric anastomosis that may reduce anastomotic tension and luminal mismatch. This technique has the potential to decrease stricture rates and warrants further evaluation in larger prospective studies. Video Description 1.Gastric conduit brought into neck 2.posterior layer of anastamosis 3.stapling of posterior layer 4.nasogastric tube placement beyond the conduit 5.blind pouch of gastric conduit is cut 6.corners of anastamosis are rearranged 7.anterior layers done in interrupted fashion
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| Authors | K V V N Raju, MADHUNARAYANA Basode |
| Journal | diseases of the esophagus : official journal of the international society for diseases of the esophagus |
| Year | 2026 |
| DOI |
10.1093/dote/doag077.422
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| URL | |
| Keywords | Keywords not found |
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