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• Stomach
• Jejunum
• Descending colon
• Ascending Colon
• Rarely : free grafts of the jejunum, stomach,
cutaneous flap,musculocutaneous or external by-pass with
silicone prosthesis.
Stomach as esophagus substitute
The stomach is the first choice for reconstruction, due to the multiple
advantages.
The stomach was mobilized by sacrificing the left arterial sources
(short gastric arteries and left gastric artery), preserving the right gastroepiploic
artery as the main arterial source
Route Choice For Reconstruction
• posterior mediastinum
• retrosternal
• presternal
• transpleural
• endoesophageal
Route Choice For Reconstruction
Retrosternal path
Advantages :
• easy to achieve.
• useful when esophageal bed is unusable.
Disadvantages :
• is a long route.
• predisposes to angulation, strangulation, affecting the substitute
vascularisation.
• unusable at the cardiac surgery patients or predisposed to such
interventions.
Triple approach technique – Mc Keown
Triple approach technique – Mc Keown
oCeliac ganglion
oHepatic artery ganglion
oCeliac trunk ganglion
- without metastases
Postoperative after three weeks
Bronchoscopy control after six months
After Bronchoscopy
• Mediastinum radiotherapy
• Death by quick alteration status at 2 weeks after
initiation of radiotherapy
Conclusions
•For well-selected cases, good results can be obtained after radical interventions.