Decompressive tube jejunogastrostomy after esophagectomy for carcinoma.

BACKGROUND/AIMS: Gastric distension after esophagectomy and reconstruction with gastric conduit can promote both pulmonary complications and conduit ischaemia. The aim of this paper is to present a method of retrograde transjejunal decompression, with special emphasis on surgical technique and specific technique-related complications. METHODOLOGY: In the period from January 2005 to December 2008 we prospectively evaluated 95 patients who underwent esophagectomy for carcinoma. In all of these patients decompressive jejunogastrostomy was employed. RESULTS: There was no peritonitis or re-operation due to the decompressive tube placement, the most common complication that occurred was cellulitis and it was present in 7 patients. Decompressive tube was usefull in preventing postoperative gastric conduit distension. No patient complained of discomfort due to the jejunogastric tube placement. Postoperative pneumonia developed in 8 patients (8.4%). CONCLUSIONS: We believe that the usage of jejunogastric tube decompression during the open esophagectomy is a safe, simple and useful technique, which improves postoperative recovery, and possibly reduces respiratory complications.

Minimally invasive surgery in the treatment of gastric cancer.

Unlike benign pathology, progress of laparoscopy in performing cancer surgery has been slow because of fear of safety and oncological adequacy. However, the initial fear has been replaced by optimism as the results from a numerous studies have shown equivalent if not superior results to open surgery. Laparoscopic gastrectomy is safe and oncologic adequate, but time consuming and technically demanding procedure. Laparoscopic surgery has gained wide acceptance in the treatment of early gastric cancer, especially of the distal stomach. The use of laparoscopic surgery for the treatment of advanced gastric cancer remains controversial. Another open question that need complete evaluation is cost-effectiveness analysis of minimally invasive and open approach.