QUESTIONS 1. How should the blood supply of the stomach be assessed to judge suitability for gastric transposition? The blood supply for the gastric transposition is based on the right gastric artery and the right gastroepiploic arteries. To get adequate length on the stomach to bring it up to the neck, one must divide the short gastric vessels, the left gastroepiploic vessels, and the left gastric artery and vein. Because of the excellent submucosal blood supply of the stomach, the gastric conduit always maintains good blood supply in the fundic area which is anastomosed to the cervical esophagus in the neck. Even with previous surgery done on the stomach, such as one or more fundoplications even with a Collis extension, the blood supply always remains excellent. 2. How can respiratory embarrassment from gastric dilation be avoided? Although, in the earlier years, pediatric surgeons were concerned that a complete transposition of the stomach behind the trachea and left main stem bronchus could cause compression of these two structures, I have never seen this problem in 129 consecutive gastric transpositions. Only one patient in my series needed an aortopexy for severe respiratory distress; however, this patient had severe tracheomalacia which was probably the main cause for the need for an aortopexy. Even if gastric dilation occurs postoperatively, respiratory distress does not happen. I have never seen it in my own series. However, if it were to occur, I would place a nasogastric tube into the gastric tran
Posted on: Thu, 20 Mar 2014 05:20:30 +0000
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