Esophageal replacement with pedunculated gastric conduit interposition and duodenal transection for refractory anastomotic leakage after esophagectomy

Abstract

BackgroundLeakage of cervical esophagogastric anastomosis is a serious complication of esophagectomy. However, there is no established way to treat the anastomosis leakage.Case presentationThe case is a 69-year-old man with locally advanced esophageal and two early gastric cancers. After induction chemotherapy, we performed minimally invasive esophagectomy, but on postoperative day 11, the anastomotic leakage was observed. Nutritional therapy, negative-pressure wound therapy, and suture closure could not treat it. Therefore, we performed pedunculated gastric conduit interposition with duodenal transection. In this procedure, the main trunk of the right gastroepiploic artery and vein was preserved, and the duodenum and gastric antrum are resected with cutting the branch from the right gastroepiploic artery and vein to gastric antrum, which dramatically improved the flexibility of the gastric conduit, and it is pulled up through the subcutaneous route. Improved blood supply and flexibility of the gastric conduit enabled a tension-free and safe anastomosis.ConclusionsThe flexibility and favorable blood flow of pedunculated gastric conduit interposition with duodenal transection can be an effective treatment option for refractory anastomotic leakage after esophagectomy.