Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Dorsal Track Control (DTC): A Modified Surgical Technique for Atraumatic Handling of the Distal Esophagus in Esophagojejunostomy

  • Lehwald-Tywuschik, Nadja (Department of Surgery, University Hospital Dusseldorf) ;
  • Steinfurth, Fabian (Center of Visceral Medicine, Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation) ;
  • Kropil, Feride (Department of Surgery, University Hospital Dusseldorf) ;
  • Krieg, Andreas (Department of Surgery, University Hospital Dusseldorf) ;
  • Sarikaya, Hulya (Center of Visceral Medicine, Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation) ;
  • Knoefel, Wolfram Trudo (Department of Surgery, University Hospital Dusseldorf) ;
  • Kruger, Martin (Center of Visceral Medicine, Department of Gastroenterology and Internal Medicine, Protestant Hospital of Bethel Foundation) ;
  • Benhidjeb, Tahar (Center of Visceral Medicine, Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation) ;
  • Beshay, Morris (Department of Thoracic Surgery, Protestant Hospital of Bethel Foundation) ;
  • Esch, Jan Schulte am (Center of Visceral Medicine, Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation)
  • Received : 2019.04.25
  • Accepted : 2019.09.20
  • Published : 2019.12.31
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Abstract

Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The 'dorsal track control' (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy.

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References

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