Use of the remnant stomach for oesophagoplasty in patients following distal gastrectomy.

Oesophageal replacement in patients following distal gastrectomy (DGE) remains a surgical challenge, and the standard option is the colonic or jejunal transplant. However, in some cases, it is possible (or mandatory) to utilize the remnant stomach for oesophagoplasty (EP). This method preserves some advantages of the gastric EP in comparison with the bowel EP. During recent years, several papers have been published in English regarding remnant stomach EP, and different aspects of this procedure have been discussed. However, there is still no comprehensive literature review analysing the possible EP approaches using the remnant stomach. A multilingual literature search (database and manual) to collect and classify the currently available data regarding remnant stomach EP following DGE and its subsequent analysis was carried out. There are a number of principally different methods of a remnant stomach EP: (1) mobilization of the remnant stomach with the spleen and tail of the pancreas with its transposition into the left hemithorax; (2) mobilization of the remnant stomach after splenectomy; (3) implementation of a reversed gastric tube, tailored from the major curve; (4) the use of a transplant fed from the right gastric and right gastroepiploic arteries; (5) the use of a transplant fed from the left gastric and short gastric arteries; (6) complete mobilization of the remnant stomach; (7) direct revascularization of the gastric stump conduit. The excellent plastic potential and rich vascularization of the stomach justify its use for EP, even after prior DGE. The majority of the methods of gastric stump EP are less well developed but should be investigated further.