Journal of Minimal Access Surgery

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Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 236--240

The technique of fourth jejunal artery-based jejunal conduit for oesophagojejunostomy after thoracolaparoscopic oesophagogastrectomy for locally advanced Siewert type II tumour

Gunasekaran Gopalakrishnan, Raja Kalayarasan, Senthil Gnanasekaran, Biju Pottakkat 
 Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Correspondence Address:
Dr. Raja Kalayarasan
Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry - 605 006
India

Background: Locally advanced long Siewert type II tumor requires total gastrectomy and D2 lymphadenectomy with distal esophagectomy and mediastinal lymphadenectomy for curative resection. In this scenario, a laparoscopic transhiatal approach is not feasible, and the conventional left thoracoabdominal approach is associated with increased morbidity. Aims and Objectives: To describe a novel technique of fourth jejunal artery based jejunal conduit for thoracoscopic esophagojejunostomy after laparoscopic esophagogastrectomy. Materials and Methods: The laparoscopic total gastrectomy with distal esophagectomy specimen is extracted through the periumbilical incision. A pedicled jejunal conduit based on the fourth jejunal artery is prepared, and the jejunal conduit is placed in the mediastinum under laparoscopic guidance. Using the thoracoscopic approach in a prone position, additional esophageal clearance and subcarinal lymphadenectomy are performed. Handsewn end to side esophagojejunostomy is performed at the level of the carina. Results: Three patients with long Siewert type II underwent this procedure after neoadjuvant chemotherapy. None of the patients had conduit related complications. All three patients had abdominal lymph node involvement and two patients had mediastinal lymph node involvement. Conclusion: Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.


How to cite this article:
Gopalakrishnan G, Kalayarasan R, Gnanasekaran S, Pottakkat B. The technique of fourth jejunal artery-based jejunal conduit for oesophagojejunostomy after thoracolaparoscopic oesophagogastrectomy for locally advanced Siewert type II tumour.J Min Access Surg 2021;17:236-240


How to cite this URL:
Gopalakrishnan G, Kalayarasan R, Gnanasekaran S, Pottakkat B. The technique of fourth jejunal artery-based jejunal conduit for oesophagojejunostomy after thoracolaparoscopic oesophagogastrectomy for locally advanced Siewert type II tumour. J Min Access Surg [serial online] 2021 [cited 2022 Jan 17 ];17:236-240
Available from: https://www.journalofmas.com/article.asp?issn=0972-9941;year=2021;volume=17;issue=2;spage=236;epage=240;aulast=Gopalakrishnan;type=0