Abstract
Gastric tube necrosis after esophagus cancer surgery is a rare but critical situation. Salvage reconstruction of the esophagus remains a challenging procedure for head and neck surgeons. Historically, surgeons have employed a two-stage salvage surgery consisting of debridement followed by reconstruction. While this procedure generates good results, the time to restart oral alimentation is long. The present report describes the case of a 62-year-old male who developed gastric tube necrosis 3 days after undergoing surgery for thoracic-cervical esophageal cancer and immediate reconstruction with the retrosternal gastric pullup technique. He was treated with debridement and simultaneous free jejunum transfer 4 days after the primary surgery. He was able to restart oral alimentation 10 days after the salvage surgery. This rapid return to oral alimentation is a major advantage of the one-stage immediate esophagus salvage reconstruction. Another advantage is the ease of the reconstructive procedure: the absence of scarring and prolonged inflammation, which are disadvantages of the two-stage procedure, meant that recipient vessel selection and anastomosis were uncomplicated. The one-step procedure may be particularly useful in cases where the inflammation is discovered early.
Highlights
Reconstructing esophageal defects has been challenging for reconstructive surgeons, but gastric pullup and colon interposition have become common procedures for total esophageal replacement
The advantages of the one-stage immediate esophageal salvage reconstruction surgery are the avoidance of recipient vessel inflammation and an early return to oral ingestion
The disadvantages of one-stage immediate esophageal salvage reconstruction surgery include the fact that it may be difficult to determine the resection margin of necrotic tissue. This is problematic because incomplete debridement could result in severe infection; the remaining inflammation could result in vascular anastomosis thrombosis [4]
Summary
Reconstructing esophageal defects has been challenging for reconstructive surgeons, but gastric pullup and colon interposition have become common procedures for total esophageal replacement. Partial necrosis at the oral side of the flap, fistula formation, or stricture sometimes occurs because of insufficient blood supply or because of too much tension at the anastomosis. In these cases, secondary surgery should be considered. The first step was the removal of necrotic tissue and the second step was reconstruction The interval between these two steps ranged from 1 to 6 months [1]. The outcomes of this treatment are acceptable and patients can start oral ingestion on average 14 days after the reconstruction step. The recipient vessel was still in good condition and further inflammation did not occur
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