A Case of esophageal reconstruction after esophagectomy due to complications after endoscopic

removal of ingested dentures using the gastric pull-up method through median sternotomy.
Rony (1, Agi Satria (2

1) Training Program in Digestive Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto
Mangunkusumo General Hospital, Jakarta
2) Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto
Mangunkusumo General Hospital, Jakarta

Jl. Diponegoro No. 71, Salemba, Jakarta Pusat 10440

E-mail: rony_kpj@yahoo.co.id

Abstract

Background :

Failure of endoscopic dentures extraction may cause esophageal perforation and mediastinitis.
Esophageal perforations are life threatening emergencies associated with high morbidity and mortality
and sometimes need esophagectomy. The second stage of esophageal reconstruction may face
difficulties due to sub-sternal adhesion of previous mediastinitis.

Case Presentation :

A-50-years old woman had undergone 20-cm Ivor Lewis esophagectomy 6 months ago due to
complications of iatrogenic esophageal injury and mediastinitis after endoscopic removal of ingested
dentures by ENT specialist. We performed esophageal reconstruction with Gastric Pull up procedure.

Result :

We performed a gastric pull-up reconstruction to replace the resected esophageal segments. A gastric
conduit approximately 3 cm in diameter was made by dividing the stomach along the greater curvature
with a linear stapler. We performed kocher manoeuver freeing up the distal part of the stomach until
the gastric conduit had sufficient length to the location of the anastomosis with the esophagus in the
neck area. During surgery, it was difficult to release the substernal cavity due to adhesion after
mediastinitis. So we performed median sternotomy and excised left sternoclavicular head to enlarge the
thoracic inlet. After releasing sub-sternal cavity from adhesion, the gastric conduit was placed in the
substernal cavity. An anastomosis esofago-gaster was performed by using a-single polydioxanone
sutures. A feeding tube was passed through the esophago-gaster anastomose until it passed pylorus.
The stomach was fixed to the diaphragm by sutures. And the sternum was fixed by wire.

Conclusion :

We report our experience with a case undergoing re-anastomosis of the esophagus and gastric tube
through a median sternotomy.

Keywords : gastric pull-up, esophageal reconstruction, median sternotomy.