392. PLANNING IS THE KEY—ESOPHAGECTOMY WITH COLONIC INTERPOSITION FOLLOWING: WHIPPLE’S, LEFT LOWER LOBECTOMY, RIGHT PLEURECTOMY AND COLONIC SURGERY

Abstract Link to Video: https://www.dropbox.com/s/wpr3s097g50oadl/Colonic%20interposition%20%28ISDE%20SUBMISSION%29.mp4?dl=0. Description of We report our learnings from a complex surgical case Ivor Lewis esophagectomy with colonic conduit in patient who had undergone multiple previous abdominal and thoracic operations. This seventy-two-year-old man was found have an esophageal adenocarcinoma (T4N0M0) the distal esophagus significant background: Whipple’s procedure for pancreatic cancer; Left lower lobectomy lung Right pneumonectomy recurrent pneumothoraces defunctioning stoma chemotherapy associated anal fistula. To knowledge, no such interposition has been reported literature extensive history. presented anaesthetic challenges which are explored video. Principally need planning anticipate risk modify procedural steps account these accordingly. For example, operation began right thoracotomy, given possibility that dense adhesions surgery could obstruct safe dissection subsequently be aborted before any critical were made. Additionally, we consider importance involving other specialities aid delineation anatomy. Each key operative described paired real-time video footage. Post-operatively describe how anastomotic leak high-risk anastomosis may reduced through pre-emptive Endoluminal Vacuum therapy. also discuss recognising managing feculent aspiration pneumonia is common following this surgery. Discussion approach would serve highlight remains feasible option patients despite anatomy history; provided risks anticipated appropriately managed.