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Highlights • The authors present a surgical option for the management of esophageal caustic injury. • The surgery consists of a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. • The technique can be indicated when esophagectomy is necessary and there is pyloric stenosis associated., Introduction Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case report, the authors opted for gastric pull-up in a case of esophageal and pyloric stenosis secondary to caustic ingestion, and a Roux-en-Y gastroenterostomy in the lower portion of the gastric pull-up. Presentation of case A 37 years-old male presented complaints of dysphagia, which had started 28 days before admission after the ingestion of a caustic liquid. An esophagogastroduodenoscopy was performed, and showed a complete occlusion of the esophagus, without the possibility of performing an esophagus dilatation or placing a nasoenteric tube. The option was made for a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. The patient was later admitted with a stenosis of the esophageal anastomosis, which was resolved after performing endoscopic dilatation. Discussion The medical team opted to use the stomach for the reconstruction of the gastrointestinal transit due to less morbidity during manipulation of that organ, as well as safer anastomosis, when compared to the colon. In this case report, the esophagus and pylorus were generally compromised, however, with no apparent damage whatsoever in the stomach. Therefore, we opted to resect the esophagus and used the stomach to perform a gastric pull-up with the exclusion of the pylorus and reconstruction with a Roux-en-Y gastroenterostomy. Conclusion The proposed surgery is an option when dealing with similar cases, where endoscopic dilatation is not an option, and there is an associated pyloric stenosis.

Objective Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure. Methods This prospective comparative study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were divided into group 1, in which conventional cervical anastomosis was performed, and group 2, in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas in group 2 patients were evaluated using indocyanine and the SPY device (Novadaq Technologies, Inc, Toronto, Ontario, Canada) before and after supercharged cervical anastomosis for esophagectomy. Postesophagectomy complications were also recorded. Results The study enrolled 80 patients, which included 62 (77.5%) men, mean age 64.3 years. Groups 1 and 2 comprised 55 patients and 25 patients, respectively. Leakage occurred in 10.5% and 0% of patients in groups 1 and 2, respectively (P = .169), whereas the corresponding anastomotic stricture rates were 14.5% and 4%, respectively (P = .260). Perfusion analyses showed a 26.5% improvement in the anastomotic area after venous anastomosis and a 34.6% improvement after arterial and venous anastomosis. Conclusions The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.

Gastro-pericardial fistula (GPF) is a rare condition, caused by trauma, benign or malignant pathology. Rare case of delayed complication of retrosternal gastric conduit for esophageal atresia presenting 18 years after surgery as GPF is discussed. Thoracoscopic excision of GPF was done. Treatment strategies for GPF require drainage of pericardium, fistula resection, defunctioning esophagostomy/gastrostomy. Thoracoscopy is better modality to manage such cases avoiding morbidity of sternotomy in moribund patient. While operating pediatric patients for gastric conduit advantage of reduced incidence of GPF in posterior mediastinal placement should be considered, because GPF might manifest as late as 18–20years.

Total laryngopharyngoesophagectomy with tracheal resection is an uncommon procedure. The resectability of a hypopharyngeal and cervical esophageal tumor typically depends on the ability to obtain clean surgical margins. The extent of the resection requires careful surgical planning and execution. Concomitant tracheal resection and manubriectomy due to tracheal invasion increases the complexity of these already challenging conditions. Although gastric pull-up procedures have been used to successfully reconstruct laryngopharyngoesophageal defects after tumor resection, a free tissue augmented reconstructive approach should be considered in more aggressive tumors with invasion of surrounding structures. Herein, we describe the use of combining gastric pull-up with anterolateral thigh free tissue transfer for optimal repair after radical tumor resection.

A simple, rapid, reliable technique to close an anterior neck defect is presented. This technique involves skin grafting directly onto the de-serosalized stomach wall following gastric pull-up reconstruction for a hypopharyngeal cancer.

Resumen Objetivo Evaluar los resultados de la reconstruccioncon una interposicion gastrica tras la realizacion de una faringolaringoesofagectomia. Material y metodos Se revisaron las historias clinicas de 12 pacientes consecutivos que fueron tratados de una faringolaringoesofagectomia entre 1995 y 2000. Todos los pacientes tenian un estadio avanzado y se les realizo una reconstruccion con una interposicion gastrica. Se valoraron en el postoperatorio la capacidad de deglucion,las complicaciones y la supervivencia. Resultados Se estudiaron 5 casos primarios de hipofaringe y 7 de esofago cervical. En 3 casos fue preciso asociar a la reconstruccion un colgajo locorregional. Se realizaron un total de 16 vaciamientos a 8 pacientes. Solo en 2 pacientes los ganglios linfaticos no estaban afectos. La mortalidad perioperatoria ocurrio en 4 pacientes de 12. En el momento del alta el 7 de los 8 pacientes presentaban una buena deglucion. Las complicaciones mas frecuentes fueron las pulmonares en un 58%. La supervivencia a los 5 anos fue del 31%. Conclusion La reconstruccion con una plastia gastrica esta indicada en aquellos casos que sea preciso reconstruir la hipofaringe y el esofago en un mismo tiempo quirurgico. Dado su elevada morbimortalidad se recomienda una cuidadosa seleccion de los pacientes.

Aspiration of gastric contents is considered a leading cause of postoperative pulmonary complications after esophagectomy and gastric pull up but has been difficult to diagnose. We used intratracheal long-term pH monitoring to evaluate the prevalence of aspiration of gastric contents in patients undergoing these operations. Continuous intratracheal pH monitoring was carried out during the first 72 postoperative hours in 16 patients with esophageal carcinoma who had undergone esophagectomy and gastric pull up. A drop in the pH to less than 4 was defined as an episode of acid aspiration. All patients except one tolerated the probe without any difficulties. Episodes of acid aspiration could be detected in 12 (80%) of 15 patients (5 of 8 after transhiatal esophagectomy, 7 of 7 after transthoracic esophagectomy, 2 of 5 with reconstruction in the anterior mediastinum, and 9 of 10 with reconstruction in the posterior mediastinum). The number of aspiration episodes was significantly higher during postoperative day 1 (P = 0.03) compared to postoperative days 2 and 3. Two patients developed pneumonia later in the postoperative course. Both of them had several episodes of acid aspiration detected by pH monitoring immediately postoperatively. Intratracheal pH monitoring is a safe, feasible, and well-tolerated method for detecting episodes of acid aspiration after esophagectomy and gastric pull up. Aspiration of gastric contents is a common phenomenon particularly during the first 24 postoperative hours after transthoracic esophagectomy and gastric pull up in the posterior mediastinum and appears to correlate with the development of postoperative pneumonia.

Although volvulus of a gastric pull-up may acutely result from iatrogenic twist at the time of gastric transposition, we have recently encountered a patient in whom a gastric volvulus developed in the late postoperative period, resulting in gastric outlet obstruction. The perioperative evaluation and operative management are discussed.

Traditional treatment of achalasia, pneumatic dilatation or surgical myotomy, results in satisfactory relief of dysphagia in 85% to 90% of patients. Unfortunately, a small percentage of patients do not respond to these therapies or remain refractory, often because of a severely dilated or sigmoid esophagus. Esophagectomy, with gastric pull up or color interposition, is the procedure of choice in these patients, which can result in satisfactory relief of dysphagia with minimal mortality. This article reviews the strategies for management of achalasia patients with refractory dysphagia.

This article examines mediastinal dissection and gastric pull-up, discussing disease staging and preoperative evaluation, surgical techniques, complications, and results of 50 cases in which either one of these surgeries was performed.