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J Thorac Cardiovasc Surg 2001;122:384-386
© 2001 The American Association for Thoracic Surgery

Brief Communications

Surgical approach by cervicosternolaparotomy for the treatment of extended cervical stenoses after reconstruction for caustic injury

Pierre Cattan, MDa, Philippe Chiche, MDa, Thierry Berney, MDb, Bruno Halimi, MDa, Karen Aïdan, MDa, Michel Célérier, MDa, Emile Sarfati, MDa, Paris, France, Geneva, Switzerland

From the Department of Digestive Surgery, Hôpital Saint-Louis, Paris, France,a and the Clinique of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland.b

Received for publication Sept 28, 2000. Accepted for publication Dec 18, 2000. Address for reprints: Pierre Cattan, MD, Service de Chirurgie Digestive Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.

Surgical treatment of extended cervical stenoses after esophagoplasty for caustic injury usually requires interposition grafts or flaps. These procedures have been used with limited success because of transplant necrosis and anastomosis fistula and stricture. Here, we describe an alternative technique consisting in the complete release of the transplant by a cervicosternolaparotomy approach to allow its advancement followed by primary anastomosis.

Operative procedure
A comprehensive cervical exploration through the previous cervical incision is performed to ascertain that stenosis is not suitable for repair by a limited cervical approach. Then, before proceeding to sternotomy, a midline laparotomy is required. The laparotomy can be justified as follows: (1) Importantly, it allows complete dissection of the abdominal part of the transplant and of its vascular pedicle up to its origin, which provides a significant gain in length; (2) it allows the cephalad mobilization of the duodenocolonostomy or jejunocolonostomy; and (3) it gives safe access to the intramediastinal part of the transplant at the lower end of the . . . [Full Text of this Article]






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