Left anterior intrathoracic reconstruction of the esophagus with omental flap for infective proximal aortic repair

Central MessageThe left anterior intrathoracic route is useful for attaching the omental flap to ascending aorta and reconstructing gastric conduit through a median sternotomy.See Commentary on page XXX. The sternotomy. See A 63-year-old woman presented emergency department with chest back pain at 5 months after undergoing graft replacement surgery acute type aortic dissection (AAAD). Computed tomography angiography (CTA) revealed an abscess around middle portion of esophagus pseudoaneurysm proximal anastomosis previous (Figure 1, A). patient required repair esophagectomy owing risk developing aortoesophageal fistula, as well possibility infection aorta. Pseudoaneurysm needed be done first because high rupture. Under general anesthesia, repeat sternotomy was performed. After systemic heparinization, cardiopulmonary bypass established by cannulating right femoral artery vein. clamped, repaired using new prosthetic graft. pump-off smooth hemostasis completed. intra-abdominal stripped off laparoscopy. total ports were installed, resected from adjacent tissue level trachea bifurcation. Next, supraclavicular incision made, sternocleidomastoid muscle placed outside, secured. sternoclavicular joint not removed, but instead, posterior region clavicular head shaved. Through incision, periesophageal resected, connection made earlier released layer abdominal esophagus. An upper medial created, stomach EndoGIA (Medtronic). then removed in inverted position incision. We selected simultaneous reconstruction this case necessary prevent infection. Esophageal via possible when performed simultaneously internal mammary had dissected lung wall side. Moreover, fixation prosthesis thoracotomy extremely difficult closed. mobilized toward lateral side, tube routed thoracic ventral space, which represented ribs where located (Figures B 2). Then site end-to-end cervical accomplished EEA Circular Stapler Tri-Staple technology. sternum closed without injuring tube. patient’s clinical condition improved surgery, she discharged 1 month postoperatively. Follow-up 2 years postoperatively unremarkable. provided informed written consent publication study data (IRB/ERB TGE02114-025; January 26, 2023). To our knowledge, there are no published reports fistula treatment repair, reconstruction, omentopexy Three common reconstructions esophagectomy: antesternal, retrosternal, mediastinal. Most procedures involve retrosternal mediastinal routes shorter length fewer cosmetic changes esophagectomy.1Okita Y. Yamanaka K. Okada Matsumori M. Inoue T. Fukase et al.Strategies aorto-oesophageal fistula.Eur J Cardio Thorac Surg. 2014; 46: 894-900Crossref PubMed Scopus (36) Google Scholar,2Kahlberg A. Grandi Loschi D. Vermassen F. Moreels N. Chakfe al.A systematic review infected descending grafts endografts.J Vasc 2019; 69: 1941-1951.e1Abstract Full Text PDF (22) Scholar fistulas occur between In situation, antesternal or severe adhesion artificial esophagogastric anastomosis. Meanwhile, used attach omentum graft.3Lee J.H. Na B. Hwang Kim Y.H. Park I.K. K.H. Surgical management aorto-esophageal late complication dissection.Korean Cardiovasc 2016; 49: 54-58Crossref (0) case, underwent resternotomy, thus we frap situ. This procedure also prevented injury during sternal closure prepared patients resternotomy future. exclusion may invasive, it eliminates dehiscence due primary esophageal prevents reinfection valid surgical option can infections its vascularity potential neovascularization.3Lee Scholar, 4Yasuda Shimono Tonouchi H. Shimpo Yada I. Successful aneurysm diverticulum.Ann 2002; 73: 637-639Abstract 5Kikuchi Endo Yamamoto Ozawa S. Miyata Kakeji al.Impact postoperative morbidity analysis esophagectomies Japanese National Clinical Database.Ann Gastroenterol 2022; 6: 46-53Crossref (13) completed believed that crucial Our operative such cases. Left feasible technique