Surgery for lower third lesions

Carcinoma of the lower third of the oesophagus requires a partial oesophago-gastrectomy via a thoraco-abdominal approach extending onto the abdomen. Before anastomosis, removal of the lesion and up to three-fifths of the stomach may be required.

Prior gastric surgery may result in too little stomach being available for this technique. Hence, a Roux-en-Y loop anastomosis of the jejunum to the oesophagus may be required:

• the length of diseased oesophagus and stomach remnant are removed
• the distal jejunum is drawn up and sutured side-on to the oesophageal remnant
• the proximal jejunum is anastomosed to the distal jejunum at a distance from the new oesophago-jejunal junction - this prevents biliary and pancreatic juice reflux