Technique for Isoperistaltic Gastric Tube for Esophageal Bypass

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There has not been described a uniformly successful method for palliation of inoperable carcinoma of the esophagus, especially malignant tracheocsophagcal fistula. A gastric tube formed from the greater curvature of the stomach is being evaluated for these patients. The blood supply is based on the right gastroepiploic vessels. Using a stapler, one can form a gastric tube sufficiently long to reach the hypopharynx. Placed substcrnally, anastomosis to the cervical esophagus is performed. In 30 patients postoperative mortality has been 13%. No tube necrosis has occurred, but anastomotic leakage has been a problem. In those patients who had esophageal bypass for palliation and were discharged from the hospital, swallowing function has been satisfactory and the average survival has been 5.2 months.

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