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Surgery for lower third lesions

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Carcinoma of the lower third of the oesophagus requires a partial oesophago-gastrectomy via a thoraco-abdominal approach extending onto the abdomen. Before anastomosis, removal of the lesion and up to three-fifths of the stomach may be required.

Prior gastric surgery may result in too little stomach being available for this technique. Hence, a Roux-en-Y loop anastomosis of the jejunum to the oesophagus may be required:

  • the length of diseased oesophagus and stomach remnant are removed
  • the distal jejunum is drawn up and sutured side-on to the oesophageal remnant
  • the proximal jejunum is anastomosed to the distal jejunum at a distance from the new oesophago-jejunal junction - this prevents biliary and pancreatic juice reflux

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