Nao

Omentum

(posterior mediastinum)

Pyloromyotomy

Stomach

(anterior mediastinum)

Right gastroepiploic artery

Stomach

(anterior mediastinum)

Right gastroepiploic artery figure 26-6 (continued) C, The tumor and fistula are converted to a neodiverticulum of the trachea. Proximal and distal esophageal ends of the "diverticulum" have been stapled and, if possible, reinforced with sutures. D, Completed exclusion of the fistula and anterior mediastinal bypass. The esophagogastric anastomosis will be reinforced by the upper half of the omental pedicle. The lower omental flap has been tucked into the mediastinum posteriorly, in the esophageal bed.

Pyloromyotomy is added because of the necessary bilateral vagectomy. A temporary feeding jejunostomy is judicious. As the disease progresses, a tracheal or tracheobronchial stent may become necessary later.

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