A NEW TECHNIQUE OF ESOPHAGOGASTROSTOMY ABOVE THE AORTIC ARCH—COVERING AND SUSPENDING OF THE ANASTOMOTIC AREA WITH MEDIASTINAL PLEURAL FLAP

The postoperative anastomotic leakage is the mostsevere complication and the principal cause of death afterresection of esophageal carcinoma. Especially, anasto-mosis above the aorta arch is accompanied by highincidence of anastomotic leakage usually with fatalprognosis. The authors improved the conventionalmethod of anastomosis by using a mediastinal pleural flapto cover and suspend the anastomotic area with excellentresult. From January 1990 to April 1995, total 210patients with esophageal carcinoma underwent surgeryresection with this procedure. No anastomotic leakageor stricture developed. Only one patient died of exten-sive myocardial infarction with an overall mortality of0.47%. The major merit of this procedure was that themediastinal pleural flap could cover the area of anasto-mosis and sustain dragging force acting on this area,providing a better condition for the anastomosis to healand thus reducing the possibility of anastomotic leakage.