Dorsal Track Control (DTC): A Modified Surgical Technique for Atraumatic Handling of the Distal Esophagus in Esophagojejunostomy
- Author:
Nadja LEHWALD-TYWUSCHIK
1
;
Fabian STEINFURTH
;
Feride KRÖPIL
;
Andreas KRIEG
;
Hülya SARIKAYA
;
Wolfram Trudo KNOEFEL
;
Martin KRÜGER
;
Tahar BENHIDJEB
;
Morris BESHAY
;
Jan SCHULTE AM ESCH
Author Information
- Publication Type:Brief Communication
- Keywords: AEG II; Esophagojejunostomy; Anastomosis, surgical; Gastric cancer; Surgical training
- MeSH: Adenocarcinoma; Anastomosis, Surgical; Esophagectomy; Esophagogastric Junction; Esophagus; Stomach Neoplasms; Sutures; Traction
- From:Journal of Gastric Cancer 2019;19(4):473-483
- CountryRepublic of Korea
- Language:English
- 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.
