Sjw

_ Esophageal excision

Cricopharyngeus muscle

_ Esophageal excision

Tracheoesophageal fistula

Esophageal bypass is constructed by cervical anastomosis of the proximal esophagus to a substernally placed stomach or colonic segment (Figure 26-6D). Blunt dissection of the substernal tunnel is usually not much impeded by prior mediastinal irradiation. The omentum is tucked into the esophageal bed to avoid leakage from the often previously irradiated residual esophageal "diverticulum." The omental pedicle may be split and one limb brought up anteriorly beside the stomach to reinforce the anastomosis. Obviously, if stomach is used for enteric reconstruction, the omentum remains attached. If colon is used, the omentum is pedicled on the mobilized right gastroepiploic artery (see Chapter 42, "The Omentum in Airway Surgery and Tracheal Reconstruction after Irradiation"). The superior and inferior mediastinum is drained.

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