Reconstruct the Resected Esophagus

Scientific Federation took initiative in the field of Surgery by introducing journal in the year of 2017. Our main intention is to support and promote a high quality comprehensive evidence-based on the recent research from the highly qualified authors. We received an article from Prof. Abdelkader Boukerrouche based on his recent research on the management of conduit ischemia and necrosis following esophageal reconstruction.

The stomach graft is the most digestive organ used to restore the intestinal continuity following esophagectomy for benign and malignant diseases. The colon and jejunal grafts are held in reserve. Graft necrosis is a dreaded and devastating complication and it is defined as death of the conduit used to reconstruct diseased esophagus. However graft ischemia is defined as inadequate blood supply to the graft. Various strategies to deal with intraoperative graft ischemia and necrosis are to be considered. Improvements of graft blood supply and delayed esophageal anastomosis or staged reconstruction are described. Vigilance is required in postoperative period to detect delayed graft necrosis.

Early identification and adequate management of delayed graft necrosis is key to achieving a good outcome for patients. Identification of suspicious clinical signs, aggressive investigation to determine viability of potential graft necrosis and timely management are crucial to reduce associated mortality rate. Therefore, multidisciplinary approach is key to an adequate management of these patients. The first and best strategy should be the prevention of graft ischemia or necrosis; the best way is the prevention of this complication. Therefore preoperative identification of patient risk factors, perioperative optimization of patient conditions and careful use of surgical techniques are the best defenses against conduit ischemia and necrosis.