Coniform gastric tube for end-to-end anastomosis during minimally invasive McKeown esophagectomy
Publication date: Available online 30 November 2019Source: The Annals of Thoracic SurgeryAuthor(s): Xi Zheng, Yu-Shang Yang, Wei-Peng Hu, Xin Xiao, Si-Yuan Luan, Long-Qi Chen, Yong YuanAbstractFor McKeown esophagectomy, gastric tube is widely used for constructing esophagogastrotomy. Traditionally, the gastric fundus is preserved for gastric tube formation in order to provide adequate length of the gastric conduit for neck anastomosis. However, gastric stump necrosis, anastomotic leakage, and postoperative gastric tube dilatation are the common postoperative complications for McKeown esophagectomy using traditional gastric tube. Here, we reported a novel coniform gastric tube shaping technique to maximally avoid conduit dilatation after the McKeown esophagectomy without nasogastric tube placement, while simultaneously maintain a tension-free and well-perfused anastomosis.
ConclusionsSimilar to tension pneumothorax, thoracic stomach syndrome requires immediate drainage of air from the thoracic cavity. However, unlike tension pneumothorax, this condition requires nasogastric tube insertion, which is the only way to safely remove the accumulated air and avoid possible complications that could occur due to percutaneous drainage. For patient safety, it might be clinically important to place nasogastric tubes after esophagectomy with whole-stomach reconstruction, even if radiographic guidance is required. In addition, clinicians should consider thoracic stomach syndrome as one of the differential...
Conclusions: The Sweet and Ivor Lewis esophagectomy are both safe and effective. A change of the surgical incision may not be the best way to increase survival, and the choice of surgical procedure should depend on the preference of the thoracic surgeon to secure the safety of the operation. PMID: 31559065 [PubMed]
AbstractBackgroundEarly postoperative enteral nutrition is recommended for patients undergoing esophagectomy; however, the optimum method of tube feeding remains controversial. Thus, the aim of this study is to assess two common enteral nutrition methods after minimally invasive McKeown esophagectomy.MethodsA randomized controlled trial was performed with 120 patients who underwent minimally invasive McKeown esophagectomy from January 2017 to December 2018. The patients were randomly divided so that 58 patients were in the jejunostomy feeding (JF) group and 62 patients were in the nasogastric feeding (NF) group. The postop...
Authors: Zhang R, Zhang L Abstract Routine nasogastric tube (NGT) placement is a common practice in esophagectomy patients. However, its continued application has been controversial in recent years. In this review, we will discuss the potential risks and benefits, including anastomosis leak, pneumonia, NGT reinsertion, patients' discomfort and hospital length of stay, to evaluate the feasibility of complete NGT omission in esophagectomy patients. PMID: 31080664 [PubMed]
Authors: Zhang R, Zhang L Abstract Delayed gastric conduit emptying (DGE) is a common complication after esophagectomy. Currently, pyloric interventions are the major prevention and treatment for DGE. In this review, we attempt to evaluate the clinical effect and safety of different pyloric interventions in esophagectomy patients. Moreover, other important management of DGE, including size of esophageal substitute, erythromycin and nasogastric tube (NGT) will also be discussed. PMID: 30863608 [PubMed]
Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition.
Condition: Esophageal Cancer Intervention: Procedure: Discharge the NG tube during the surgery Sponsor: Fudan University Not yet recruiting - verified August 2017