PMC9791816_01
Pre operative anatomy:. Localization of the lesion on lower third of the esophagus. Anatomy explained by history of sleeve gastrectomy and Roux-en-Y gastric bypass.
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Due to the localization and the early stage of the ADK (Fig. 1), a resection of the lower esophagus with the eso-gastric junction and the gastric pouch was considered.
Planned reconstruction: Eso-jejunal anastomosis on the Roux-en-Y alimentary limb.. Initial reconstruction plan is to use the Roux-en-Y alimentary limb for an eso-jejunal anastomosis, after en bloc resection of the cancer.
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The planned reconstruction was to use the Roux-en-Y (RY) alimentary limb to either realize an eso-jejunal anastomosis (Fig. 2) or even a double tract reconstruction (Fig. 3) as it may diminish the risks of postoperative malnutrition.
Post operative anatomy.. Colonic interposition of the transverse colon between the cervical esophagus and the Roux-en-Y alimentary limb.
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We therefore made a total esophagectomy with blunt dissection of the thoracic esophagus and a colonic interposition between the cervical esophagus and the RY alimentary limb to restore digestive continuity (Fig. 4, Fig. 5).