The pathological characteristics of esophageal cancers are p

The pathological characteristics of esophageal cancers are presented in Table 4. Positive microscopic circumferential margins were observed in one patient, but all proximal and distal margins were clear.
Discussion The total or subtotal crth2 receptor is used as an esophageal substitute because of its rich vascular supply and elasticity. A gastric conduit 4–5 cm in diameter and supplied by the gastroepiploic arcade is typically recommended. However, Tabira et al demonstrated that the width of a gastric tube does not affect the vascular supply, leakage incidence, or postoperative nutritional status. Luketich et al described laparoscopic mobilization of the stomach and indicated that a narrow gastric tube (3–4 cm in diameter) was associated with an increased incidence of gastric tip necrosis and anastomotic leaks; therefore, they recommended a gastric tube diameter of 5–6 cm. Rather than abiding by the width criterion during gastric tube construction, we recommend designing the gastric conduit according to its surface blood supply, a technique that is more intuitive and efficient (Figure 1B). Our modified intracorporeal method differs from conventional gastric tube construction. We shaped the gastric tube according to its surface vascular supply rather than the gastric tube width. When gastrostomy is performed at the apex of the conduit for applying the circular stapler, arterial and venous bleeding at the cut edge are easily observed, which serve as effective indicators of perfusion at the apex. In our experience, a neoesophagus with an average width of 3.74 cm is the optimum. Gastric tubes constructed according to the surface blood supply have a narrower diameter than do conventional gastric tubes. The critical step in gastric tubulization is preserving the blood supply of the gastric tube. Therefore, we suggest constructing the gastric tube on the basis of its surface blood supply rather than the width of the gastric tube. Therefore, considering the structure of the posterior mediastinum, a slender gastric tube fits well in the narrow space of the upper mediastinum. A wide gastric tube may cause lung compression. A small-diameter gastric conduit empties more efficiently, thus avoiding gastric stasis. We previously reviewed 26 patients who had undergone MIE between September 2009 and August 2010. The rate of anastomosis leakage was 15.4% (4/26). Moreover, we constructed the laparoscopic gastric tube on the basis of the stomach width (5–6 cm). In 2013, we began constructing the gastric tube by shaping the tube according to the surface vascular supply rather than the gastric tube width. Surgical assistants play a crucial role in laparoscopic intracorporeal gastric tube construction. While the assistant applies gentle traction on the greater curvature of the stomach and appropriately aligns the stomach, the surgeon accurately applies the staple cartridges (Figure 1C). Because the staple line is rigid, its length on the gastric tube should be longer than, or at least equal to, the length of the reconstruction route. Consequently, at least five 60-mm long EndoCutter cartridges are required for constructing a gastric tube sufficiently long to reach the neck. In our experience, the average length of the gastric tube above the sternal notch was 7.65 cm. Because of the extra length of the gastric tube, an anastomotic site away from the esophagogastric junction, potentially the most ischemic area of the gastric tube, can be selected. Anastomosis should be as low as possible on the greater curvature of the gastric tube and should be completely tension free. Liebermann-Meffert et al demonstrated that a gastric tube is mainly supplied by the gastroepiploic arcade and that the contribution of the right gastric artery is negligible. Thus, we created the anastomosis as close as possible to the root of the right gastroepiploic vessels.
Introduction Ventriculoperitoneal shunting (VPS) is the most widely used procedure for treating hydrocephalus. Although it is effective and safe, VPS may cause various complications, such as shunt obstruction, catheter disconnection or loss, intestinal obstruction, inguinal hernia, ascites, intestinal volvulus, bowel perforation, extrusion through the umbilicus or abdominal incision, and pseudocyst formation, and has a complication rate of 24–47%. Intra-abdominal complications account for ∼10–30% of all complications. Intestinal perforation is a rare VPS complication, with an incidence estimated at 0.1–2.5%. Patients experiencing intestinal perforation may be asymptomatic or present symptoms, such as abdominal pain, vomiting, fever, shunt malfunction, abdominal abscess, and peritonitis. Furthermore, the distal end of the peritoneal tube may migrate to the heart, urethra, or anus through the bowel or umbilicus. Among these migrations, transanal protrusion of the peritoneal tube is rare, but commonly recognized, and facilitates the diagnosis of intestinal perforation. Additionally, all patients manifesting transanal protrusion of the peritoneal tube have a bowel perforation in the colon. In this report, we present the case of a 3-year-old boy with a small-intestinal perforation and peritoneal-tube transanal protrusion 18 months after VPS. A literature review revealed that this is the first report of such a case.