Omentoplasty Group Research Articles

Omentoplasty for pelvic defect closure following abdominoperineal resection in lower rectum cancer

BackgroundThe perineal wound is considered an important source of postoperative morbidity and mortality following abdominoperineal resection (APR). Complications include wound dehiscence, infection, abscess, perineal herniation, radiation enteritis, persistent sinus, more nursing effort, prolonged hospital stay, and increase readmission with cost increase.AimThe aim of this study is to compare the result of conventional closure of pelvic defect following APR versus closure with omentoplasty.Patients and methodsThis study included 30 patients who underwent APR. The patients were divided into two groups: omentoplasty group included 15 patients who underwent pelvic defect closure using pedicle omental flap, and conventional group included 15 patients who underwent surgery with conventional closure of pelvic defect.TechniqueVoluminous omental flap is harvested with proper length, with good perfusion and vascularity. Then, it is used as plug for closure of the dead space in the pelvis obtained after APR.ResultsPedicle omental flap fashioning, mobilization, and transposition supporting perineal defect following APR results in reduction of pelvic dead space and enables safe closure with reasonable operative time and reduction in postoperative wound complications.ConclusionOmentoplasty for closure of pelvic defect following APR is an applicable and safe method that supports perineal wound closure with less complications.

Usefulness of Omentoplasty to Reduce Perineal Wound Complications in Abdominoperineal Resection After Neoadjuvant Chemoradiotherapy

Omentoplasty is sometimes used to prevent perineal wound complications after abdominoperineal resection (APR) following neoadjuvant chemoradiotherapy (NACRT). However, recent studies have raised some controversy about its clinical benefit. Outcomes for rectal cancer patients who received APR after NACRT were retrospectively compared between the groups with omentoplasty (n=28) and without omentoplasty (n=14). The operative time was significantly longer in the omentoplasty group (575 vs. 404 min, p<0.001). Laparoscopic surgery was performed more frequently in the omentoplasty group. Perineal wound problems including dehiscence and infection were significantly reduced in the omentoplasty group (46.4% vs. 78.6%, p<0.001). Univariate and multivariate analyses revealed that omentoplasty was the most important factor in reducing perineal wound complications (odds ratio=0.020, 95% confidence intervaI=0.001-0.393; p=0.001). Omentoplasty was useful in reducing perineal wound complications after APR following NACRT.

The efficacy of laparoscopic lauromacrogol sclerotherapy in the treatment of simple hepatic cysts located in posterior segments: a refined surgical approach.

Hepatic cysts in located posterior segments close to the diaphragm (IVa, VII, and VIII) reportedly have a high recurrence rate. Presently, laparoscopic omentoplasty is the accepted technique; developed from laparoscopic deroofing, which places a viable pedicle flap of omentum to prevent cyst closure. However, potential adhesions have made laparoscopic omentoplasty less favorable. In this paper, we report on an improved surgical technique involving lauromacrogol sclerosis directly under laparoscopic fenestration. We also review and evaluate the efficacy and feasibility of this refined surgical approach. Data from 49 patients admitted to the Department of Hepatobiliary Surgery at the Affiliated Hospital of Jiangnan University from October 2015 to June 2020 with simple hepatic cysts located in the IVa, VII, and VIII segments were retrospectively analyzed. All patients were symptomatic before admission. They were separated into two groups based on the surgical approach they had received; refined laparoscopic lauromacrogol sclerotherapy or laparoscopic omentoplasty, and were compared and evaluated in terms of the postoperative cyst volume and quality of life. No significant differences in sex, age, preoperative cyst volume, surgery duration, hospital stay, and bleeding volume were reported. There were no deaths or major complications in both groups. The postoperative cyst volume was significantly reduced in the laparoscopic lauromacrogol sclerotherapy group (2.48 cm) compared to the laparoscopic omentoplasty group (3.90 cm). This study evaluated both the immediate and medium-term results with a 3-12 months follow-up period for all patients. The cyst volume change in the laparoscopic lauromacrogol sclerotherapy group was found to be significantly greater than that of the laparoscopic omentoplasty group. The feedback regarding quality of life did not vary significantly between the two groups, except for general health and health change, where patients who received laparoscopic sclerotherapy responded with higher scores. Our results indicate that laparoscopic lauromacrogol sclerotherapy surgery was safe and effective in patients with IVa, VII and VIII segment simple hepatic cysts.

Comparison of omentoplasty and tube drainage as treatment option in hydatid liver disease: A retrospective hospital-based observational study

BACKGROUND: Hydatid disease remains an important parasitic infection requiring surgical intervention. The liver is the most common site of infection, and several methods of surgery have been described to treat this common disease. Extensive research is going on to find the best operative treatment procedure for hydatid liver diseases. AIM: The aim of the study was to compare the results of two surgical methods used in the treatment of hydatid disease of the liver, namely omentoplasty and tube drainage. MATERIALS AND METHODS: Fifty-seven cases of hydatid liver were treated from January 2005 to January 2011, out of which thirty patients were treated with omentoplasty (Group A) and 27 were treated with tube drainage (Group B). The results of the surgery in terms of mortality, complications, hospital stay, and recurrences were analyzed by unpaired t-test or Fisher's exact test, and P value was calculated. RESULTS: Overall postoperative complications were seen in 9.4% in Group A and 22.5% in Group B. The average hospital stay and time to resume routine work in Group A was shorter as compared to Group B. The percentage of complications such as wound infections and abscesses formation were 3.4% each in omentoplasty group and 11.2% and 7.2% in tube drainage group, respectively. The comparison of infection frequency among two groups showed strong statistical significance withP = 0.002 in wound infection and 0.0014 in abscess formation. The comparison of jaundice development after both procedures was statistically insignificant (P = 0.037). No patient in omentoplasty group developed biliary fistula, and the percentage of this complication in tube drainage was 3.7%. The recurrence of hydatid disease in omentoplasty was nil and 7.41% in tube drainage patients. There were no recurrences in either group for a follow-up of 4 years. CONCLUSION: Omentoplasty is better and must be preferred operative procedure than tube drainage in the treatment of hydatid cyst liver disease.

Omentoplasty Decreases Leak Rate After Esophagectomy: a Meta-analysis

ObjectiveTo compare the efficacy of omentoplasty with non-omentoplasty in the prevention of postoperative anastomotic leakage, and to investigate the safety of omentoplasty. MethodsLiterature searches were performed of the Medline, EMBASE, and Cochrane Library databases. Studies that compared the efficacy of omentoplasty and non-omentoplasty after esophagectomy were selected. A meta-analysis was performed on anastomotic leakage, anastomotic stenosis, hospital mortality, and length of hospital stay. Results were reported as odds ratio (OR), weighted mean difference (WMD), or relative risk (RR), with 95% confidence intervals. ResultsSix studies involving a total of 1608 patients met inclusion criteria. Compared with the non-omentoplasty group, the incidence of anastomotic leakage in the omentoplasty group (OR, 0.37; 95% CI, 0.23–0.60; P < 0.0001) was significantly reduced and the length of hospital stay (WMD, 2.13; 95% CI, 3.57–0.69; P = 0.004) was significantly shortened. However, there was no significant difference in the incidence of anastomotic strictures (OR, 0.82; 95% CI, 0.37–1.80; P = 0.61) or in-hospital mortality (OR, 0.61; 95% CI, 0.25–1.51; P = 0.29). ConclusionsOmentoplasty after esophagectomy is a safe and effective method to prevent anastomotic leakage.

The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

Omentoplasty versus tachosil in preventing leakage after colonic anastomosis

Context Leak from an intestinal anastomosis is the complication most feared by colorectal surgeons. The role of omentoplasty in securing colorectal anastomoses is controversial. Collagen-bound fibrin sealant sheets have recently been used in many aspects of surgery and many experimental animal studies have proven its efficacy in securing gastrointestinal anastomoses. The safety and feasibility of a collagen-bound fibrin sealant has been proven. Its application in sealing colonic anastomosis is a new field and needs to be evaluated. Aim The aim of this study was to evaluate and compare the efficacy of omentoplasty versus TachoSil in decreasing the rate of anastomotic leakage in colorectal anastomoses. Settings and design This is a prospective randomized trial. Materials and methods Ninety-seven patients with colonic anastomosis were divided into two groups; 48 were subjected to omentoplasty and 49 to TachoSil for prevention of leakage. The patients were followed up for symptoms and signs of leakage postoperatively. Statistical analysis Continuous variables were expressed as means and SD. Categorical variables were expressed as frequencies and percentage. Results The rate of clinical leakage in the omentoplasty group was 8.3% and that in the TachoSil group was 2%, which was within the reported range of 1.5–16%. Three out of four leakages in the omentoplasty group were severe (>500 ml/day) and the only case in the TachoSil group was less severe ( P Conclusion The study proved that TachoSil is more effective than omentoplasty in preventing anastomotic leakage. The use of the collagen-bound fibrin sealant TachoSil appears to be beneficial, being better than omentoplasty with respect to the length of hospital stay and severity of leakage, if leakage is inevitable.

Wrapping colonic anastomoses: Omentoplasty versus a carrier­ bound fibrin sealant

Introduction: A leak from an intestinal anastomosis is the complication most feared by the colorectal surgeon. The role of omentoplasty in securing colorectal anastomoses shows some controversy: being recommended by some authors, being of equivocal value to others and to be recommend against by a third group of authors. Collagen-bound fibrin sealant sheets have recently been used in many aspects of surgery; for example: Hernia, GI, ophthalmic, gynecologic & obstetric, renal, vascular and cardiac surgeries; and many experimental animal studies proved its efficacy in securing GJ anastomoses. The safety and feasibility of using collagen-bound fibrin sealant has been proven. Its application for sealing colonic anastomosis is a new field of its application and needs to be evaluated. Aim: To evaluate and compare the efficacy of both omentoplasty and a newly introducedfibrin sealant; TachoSil®; in decreasing the rate of anastomotic leakage in colorectal anastomoses. Results: 97 patients were included; 48 in omentoplasty group and 49 in TachoSil® group. The rate of clinical leakage in omentoplasty group was 8.3% and in TachoSil® group was 2%. Three out of four leakages in the omentoplasty group were sever(>500 cc/day) and the only case in TachoSil® group was less sever (<500 cc/day). The average hospital stay in omentoplasty group was 9.3 days and in TachoSil® group was 7.2 days (P<0.05). Conclusion: Omentoplasty proved no beneficial effect in sealing colonic anastomoses. There is a trend proving that TachoSil® is more effective than omentoplasty in preventing anastomotic leakage. The use of the collagen-bound fibrin sealant TachoSil® appears to be beneficial, being better than omentoplasty regarding the length of hospital stay and the severity of leakage, if leakage is inevitable.

Pericardial flap: an effective method of surgical repair of late post-pneumonectomy fistula.

We report our experience with the surgical closure of late post-pneumonectomy bronchopleural fistula (PBF) using our own method of coverage of the bronchial stump: Pedicled pericardial flap in combination with fibrin glue. We reviewed the surgical results of 33 patients who underwent surgical closure of PBF by thoracotomy access using three methods: Myoplasty (MYO)-12, omentoplasty (OMT)-10, and pedicled pericardial flap (PPF) with fibrin glue-11. Post-operative follow up was six months. The patients' demography was comparable among the groups. The diameter of the fistulas ranged from 5 mm to total dehiscence. The mean time of the fistula manifestation (in weeks) was 21.5 in the MYO group, 19.50 in the OMT, and 20.1 in the PPF group. The shortest period of hospital drainage of the pleural space was noted in the PPF group. Healing of the fistula was obtained in 66.67% in the MYO group, 80% in the OMT, and 100% in the PPF group. The number of complications was similar in all groups. The hospitalization time was significantly shorter in the PPF group (13.00 d) versus the MYO group (19.58 d) and the OMT (20.01 d). Overall mortality rate was 18.18%; 33.33% of the patients in the MYO group and 20% in the OMT group died. There were no hospital deaths in the PPF group. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of postpneumonectomy PBF in selected patients. Compared with other methods of bronchial stump coverage (omentopasty and myoplasty), this one showed a higher percentage of healing of the fistulas and shorter duration of hospital drainage and hospitalization.

Omentoplasty is effective in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy and reducing the mortality during the anastomotic leakage

We read with interest the article by Zheng et al. [1] on omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy. Oesophagectomy remains the standard surgical treatment and is effective for early-stage tumours confined to the oesophagus and the paraoesophageal region. As a major complication, anastomotic leakage often causes considerable morbidity and mortality after oesophagectomy. Prevention of anastomotic leaks would therefore reduce patient mortality following oesophagectomy. In our hospital, we use a mechanical stapled anastomoses followed by the omental wrapping method, for preventing anastomotic leaks. In our clinical trial study, we noticed that this method performed on 255 patients with oesophageal cancer contributed to less anastomotic leaks (1%, P < 0.05), as well as less anastomotic strictures (6%, P < 0.05) [2]. When anastomotic leakage occurred in the patients in the omentoplasty group and the stapled group, the drainage procedure was often used. However, we noticed that the mortality and healing time in the omentoplasty group was obviously lower than that of the stapled group. From those randomized controlled trials, it seems clear that omentoplasty can prevent anastomotic leakage without additional risks, and furthermore we concluded that this technique can reduce the mortality and healing time when the anastomotic leakage had occurred.

Comparison of gastrotomy closure modalities for natural orifice transluminal surgery: a canine study

Reliable closure of the gastrotomy after transgastric natural orifice transluminal endoscopic surgery (NOTES) remains unresolved. To compare the technical aspects and clinical and histologic outcomes of NOTES gastrotomy closure techniques. Experimental study. Animal laboratory. Thirty-four dogs, 14 for nonsurvival study and 20 for survival study. The animals randomly received different gastrotomy closures after NOTES: endoclip, omentoplasty, over-the-scope-clip (OTSC), and hand-suturing. Procedure time, closure strength, survival, postoperative adverse events, and histologic evaluation of wound healing. Omentoplasty and OTSC groups needed shorter procedure times and fewer clips than the endoclip group. The endoclip and omentoplasty groups generated similar leakage pressures (34.5 ± 2.6 vs 42.2 ± 4.1 mm Hg, P > .05), both lower than OTSC and hand-suturing groups (81.5 ± 2.1 and 87.0 ± 3.0 mm Hg, respectively, P < .001). Of the 20 animals in the survival study (all 4 groups), only 2 of 6 in the endoclip group were killed prematurely due to sepsis. Necropsy revealed the OTSC group reached a 100% clip retention rate, higher than the endoclip (47.9%) and omentoplasty groups (44.4%, P < .05) rates. Complete healing, defined as intact and continuous gastric layers microscopically, was seen in 83.3% of animals (5 of 6) in the omentoplasty group, comparable with OTSC (4 of 6, 66.7%, P = .500) but higher than the endoclip group (1 of 6, 16.7%, P = .04). Animal study. Omentoplasty is easier and safer for NOTES gastrotomy closure than endoclips and offers safety profile and efficacy similar to OTSC and hand-suturing.

Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy

Anastomotic leakage is a major cause of mortality in oesophageal surgery. Whether omentoplasty after oesophagogastrostomy could reduce anastomotic leakage is still controversial. The aim of this study is to investigate the function of omentoplasty to reinforce cervical oesophagogastrostomy after radical oesophagectomy with three-field lymphadenectomy. A total of 184 patients who underwent radical oesophagectomy with three-field lymphadenectomy took part in this prospective study. Patients were randomized to receive either the omentoplasty or non-omentoplasty. In the omentoplasty group, the omentum was wrapped around the oesophagogastric anastomosis after oesophagogastrostomy. Age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease, peripheral vascular disease and performance of omentoplasty were recorded. The anastomotic leakage and stricture and recurrence site were followed up for three years after the operation. The two groups were comparable in terms of age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease and peripheral vascular disease (P > 0.05). In contrast to the non-omentoplasty group with a postoperative anastomotic leakage rate of 9.8%, the omentoplasty subjects demonstrated a significantly lower rate of 3.3% (P < 0.05). No lethal leakage was found in the omentoplasty group, while two non-omentoplasty patients developed incurable empyema and mediastinitis due to leakage and ultimately died. The rate of incidence of anastomotic stricture in the omentoplasty and non-omentoplasty groups were 4.3% and 2.2% respectively. Of the five cases of death during the hospital stay, two were found in the omentoplasty group and three in non-omentoplasty. There was no significant difference of lethal leakage, stricture and death rate between the two groups (P > 0.05). The hospital stay was significantly longer for non-omentoplasty patients, compared with that for the omentoplasty subjects (P < 0.05). Tumour recurrence in lymphatic- or haematogenous metastasis was similar in both groups (P > 0.05). Omentoplasty may prevent anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.

Comparative Study of Three Modalities of Endoluminal Approaches for Closure of Gastrotomy after NOTES

Purpose: Reliable closure of transgastric NOTES access with simple technique is greatly needed. The aims of this study were (i) to systematically compare effectiveness and reliability of three endoluminal approaches for gastrotomy closure to open surgical hand suturing and (ii) to re-validate the role of omentoplasty in closure of balloon-created gastric defects. Methods: Standard gastrotomy accesses were created by endoscopic needleknife incision and balloon dilation. After completing exploratory peritoneoscopy, the democratic dogs were randomly assigned to four groups: the gastric defects in group A were closed by Endoclip; group B used omentoplasty; group C used the over-the-scope clip system (OTSC); and group D served as a control with hand suturing via open surgery. In non-survival experiments, leak-proof tests were performed. Other 20 dogs after closure were survived two weeks. On necropsy, the healing in gastrotomy site, clip retention, intraperitoneal infections, tissue adhesions, and injury of adjacent organs were evaluated, and the gastrotomy site was excised for histological assessment of wound healing. Results: Successful gastrotomy closures were performed in all cases. Mean procedure duration was shorter for omentoplasty closure (6.0±1.1 min) and OTSC group (6.5±1.3 min) compared to Endoclip group (34.9±12.4 min), (P<0.001, no statistical difference between omentoplasty group and OTSC group). Leakproof test revealed the burst pressure in OTSC group was (81.5±10.6mmHg) comparable to that of hand suture group, and higher than that of omentoplasty group (43.0±11.5 mmHg) or Endoclip group (36.3±12.5 mmHg) (P=0.002, no statistical difference between omentoplasty group and OTSC group). 2 dogs in Endoclip group died 1 week after closure due to leakage of closure and peritoneal abscesses, and the remaining 18 animals survived for two weeks with no signs of illness. With exception of the two dogs died in Endoclip group, all gastrotomies healed satisfactorily without leakage and no significant intraperitoneal infections or adhesions were detected. Complete healing of gastrotomy site achieved in all animals of OTSC and omentoplasty group, and the apparent incorporation of omentum flap into gastric wall was easily identified in omentoplasty group. Conclusion: Both omentoplasty and OTSC can reliably make closure of gastrotomy accesses for peroral NOTES with comparable results to surgical hand suturing. Omentoplasty in gastrotomy site, despite of a relative low burst pressure, can effectively seal the transgastric opening with technical simplicity and facilitate the wound healing process through histological remodeling into gastric wall.

Influence of omentoplasty on colonic anastomosis in animals submitted to hemorrhagic shock in rats

To analyze influence of omentoplasty on anastomosis in descending colon of rats. Rats were submitted to the hypovolemic shock of the hemorrhagic type by the Biomechanical Test of Pressure of Rupture by Liquid Distension (BTPRLD). In addition, establish a type of acute anemia in rats that are provided to the study. Comparative study between two groups of animals with ten rats in each one, all submitted to hemorrhagic shock for 30% volemic removal by the carotid artery. An anastomosis was performed in left colon. An anastomosis was performed in the left colon. Group 1 took place anastomosis with Polyvinyl Chloride (P.V.C) film to prevent the adhesions formation on sature line. Group 2 placed the great omentum around the anastomosis. Euthanasia occurred on the fifth day, when the anastomoses were submitted to the biomechanical test of pressure of rupture by liquid distension (BTPRLD). High rupture pressure was gained with omentoplasty group in relation to the group in which anastomosis was protected from adhesions formation. A statistical significance was noted. Protection by great omentum has increased the anastomosis resistance of the shocked animals. Also, the proposed hemorrhagic shock type has proven to be useful for this study.

Omentoplasty in the prevention of anastomotic leakage after colorectal resection: a meta-analysis

Whether omentoplasty after colorectal anastomosis can reduce anastomotic leakage is controversial. Our aim was to do a meta-analysis of randomized controlled trials to compare anastomotic leakage rates between an omentoplasty group and a no omentoplasty group after colorectal anastomosis. We searched the Cochrane Center Register of Controlled Trials, PubMed, EMBASE, and Chinese Biomedical Literature Database up to June 2008 in any language. Reference lists from all selected articles were also examined. Randomized controlled trials of omentoplasty in the prevention of anastomotic leakage after colorectal resection were selected and evaluated by two investigators. Analyses were performed using Review Manager 4.2. Three randomized controlled trials totaling 943 participants were included. Meta-analysis results showed that no statistically significant difference was found between the omentoplasty group and the no omentoplasty group in radiological anastomotic leakage (RR 0.76, 95% CI 0.41 to 1.40), death (RR 1.01, 95% CI 0.55 to 1.86), and repeat operation (RR 0.60, 95% CI 0.35 to 1.05), except for clinical anastomotic leakage (RR 0.36, 95% CI 0.16 to 0.78). Based on available data from a small number of trials, there is not enough evidence to say whether or not omentoplasty should be used to reduce anastomotic leakage after colorectal resection. The decision as to whether we should continue to use this technique might remain a matter of surgical judgment. Therefore, the results still need to be confirmed by future multicenter, well-designed trials.

Omentoplasty versus no omentoplasty for esophagogastrostomy after surgery for cancer of cardia and esophagus

The standard of care of patients with cancer of cardia and esophagus still remains surgery in early stage. One of the most feared complications after such procedure is anastomotic leak. We present our experience with omental wrapping of anastomosis (omentoplasty) to decrease the anastomotic leak. Retrospective study. An analysis of 50 consecutive patients, who underwent surgical resection for cancer of cardia and esophagus at BPKMCH, is done. For cancer of esophagus, a 10 cm proximal tumor free margin and for lesions of cardia, at least 5 cm margin was achieved. A 5 cm distal tumor free margin was achieved in each case. A subset of patients was considered for omentoplasty after completion of anastomosis. There were 29 male and 21 female with a mean age of 56.3 years. The average postoperative stay was 13.14 days. The stomach was the organ of substitute in 48 and jejunum in 2 cases. Omentoplasty was done in 37 cases, whereas in 13 cases, no omental wrapping was done. The rate of anastomotic leak was 6%. There was no leak from anastomosis placed at chest, whereas three cases of leak was observed in the anastomosis at the level of neck (P=.013). Overall, there was no leak in omentoplasty group, whereas there were three cases with leak in the group without omentoplasty (P=0.003). Omentoplasty should be considered in every case after surgical resection for cancer of cardia and esophagus.