Vascular problems in gastric esophagoplasty after esophagectomy or circular pharyngolaryngectomy

Gastric oesophagoplasty (GOP) after total oesophagectomy or circular pharyngolaryngectomy is complicated by an average anastomotic breakdown or fistula rate of 15%, and a stenosis rate of 8%. Ischemia related to the actual procedure itself undoubtedly plays a role in the production of such complications in spite of the rich vascular supply to the stomach. The authors report the results of an anatomical study involving 24 stomachs from non-embalmed adults studied by various forms of arteriography depending in the GOP technique employed. For healthy normotensive gastric arteries, they demonstrate the principal elements likely to influence the vascularisation of the graft and propose a provisional vascular score for ischemia. Based on this, they discuss the vascular risks associated with GOP techniques in general.