Robroy H. MacIver, MD, Sudhir Sundaresan, MD, Alberto L

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Mucosal Tube Technique for Creation of Esophageal Anastomosis After Esophagectomy Robroy H. MacIver, MD, Sudhir Sundaresan, MD, Alberto L. DeHoyos, MD, Mark Sisco, MD, Matthew G. Blum, MD The Annals of Thoracic Surgery Volume 87, Issue 6, Pages 1703-1707 (June 2009) DOI: 10.1016/j.athoracsur.2009.03.057 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Performing the myotomy with a knife. Allis clamps are used to grasp the staple line of the transected esophagus. The stapled transection of the esophagus is 2 to 3 cm distal to the intended level of anastomosis and allows removal of most of the gastroesophagostomy specimen. This also allows improved visualization of the esophagus, facilitating creation of the myotomy. Note the staple line is not the final margin. (Arrow = esophageal mucosa * = gastric conduit). (B) Sweeping the myotomy to clear the mucosal tube. (C) The mucosa is transected at the border of the distal muscularis to leave a 1- to 2-cm mucosal tube. (D) The cut mucosal tube before suturing the anastomosis. The Annals of Thoracic Surgery 2009 87, 1703-1707DOI: (10.1016/j.athoracsur.2009.03.057) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Outer corner sutures are placed in the seromuscular tissue of the stomach and the muscular esophagus. The dotted line shows line of gastrotomy. (B) The posterior outer suture line has been completed. (C) The posterior inner layer has been partially completed. Two corner sutures are placed first (one tied and cut and one untied in the diagram) to ensure that there is no infolding of the mucosa and facilitate accurate mucosal approximation. (D) Completed posterior rows with nasogastric tube in place. The Annals of Thoracic Surgery 2009 87, 1703-1707DOI: (10.1016/j.athoracsur.2009.03.057) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions