Management of Conduit Ischemia and Necrosis following Esophageal Reconstruction

Introduction The stomach graft is the most common digestive organ used to restore the intestinal continuity following esophagectomy for benign and malignant diseases. The colon and jejunal grafts are held in reserve .Graft necrosis is a dreaded and devastating complication and it is defined as death of the conduit used to reconstruct diseased esophagus. However graft ischemia is defined as inadequate blood supply to the graft. Fortunately, the reported incidence of graft necrosis is less than 2% after primary reconstruction [1, 2]. Graft necrosis is a grave complication which threatens the patient life and affects functional results. Mortality rate after conduit necrosis exceeds 90% [3,6] .Various strategies to deal with intraoperative graft ischemia and necrosis are to be considered. Improvements of graft blood supply and delayed esophageal anastomosis or staged reconstruction are described in detail. Vigilance is required in postoperative period to detect delayed graft necrosis. Early identification and adequate management of delayed graft necrosis is key to achieving a good outcome for patients. Identification of suspicious clinical signs, aggressive investigation to determine viability of potential graft necrosis and timely management are crucial to reduce associated mortality rate. Therefore, multidisciplinary approach is key to an adequate management of these patients. The first and best strategy should be the prevention of graft ischemia or necrosis; preoperative identification of high-risk patients, careful use of surgical techniques and introperatve use of methods to improve graft vascularity are essential to prevent this serious complication