Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3971
Peer-review started: December 21, 2020
First decision: February 11, 2021
Revised: February 26, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 6, 2021
Processing time: 143 Days and 12.9 Hours
Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks, fistulas or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperations may be necessary. Here, we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.
A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital. Since endoscopic approaches including balloon dilatation and stenting failed, retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.
Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
Core Tip: Esophageal surgery with gastric pull-up reconstruction remains the only curative therapy for malignant tumors of the esophagus. Despite significant progress in minimally invasive techniques and improvements in perioperative care/complication management, it is still associated with high rates of morbidity and mortality such as anastomotic leak, fistula and stenosis. One of the most frequent long-term functional complications of esophageal surgery with gastric pull-up is delayed gastric emptying which can be usually treated successfully by endoscopic approaches. However, there are cases with a therapy-refractory complaints where salvage operations are required. Here, we present such a case where an operation with secondary colonic pull-up after oncological esophagectomy with gastric tube reconstruction was performed due to pseudoachalsia caused by an anastomotic stenosis that was refractory to endoscopic interventions.