A new technique for substernal colon transposition with a breast dissector: Report of 39 cases

https://doi.org/10.1016/j.bjps.2005.09.041Get rights and content

Summary

This paper investigates the effectiveness of the breast dissector to create a substernal space for oesophageal reconstruction. The surgeon must be extremely careful while dissecting the tissue below the sternum in order to avoid pneumothorax. The endoscopically assisted preparation of the substernal route is safe but it requires appropriate training.

A retrospective study on 68 patients who underwent oesophageal reconstruction was done analysing the patients' records. In 39 cases, the breast dissector was used. In 29 cases, the substernal tunnel was created with hand dissection only.

All 68 colon segments were successfully transferred in the two groups of patients. In all 39 the cases where the breast dissector was used no pneumothorax followed. In 10 (34%) patients of the control group pneumothorax occurred.

Concluding, no more pneumothorax has occurred during the substernal oesophageal reconstruction since we started using the breast dissector.

Section snippets

Materials and methods

Between 1998 and 2004, 39 patients underwent oesophageal reconstruction due to caustic ingestion. There were 27 women and 12 men, aged from 7 to 70 years. The oesophagectomy and the reconstruction were performed at our Department of Plastic Surgery. The patients have been directly referred to the senior author (Hung-Chi Chen) who performed the reconstructive procedures.11, 12, 13 The thoracic oesophagectomy was performed endoscopically by the thoracic surgeons.

A pedicled colon segment was

Results

All 68 colon segments were successfully transferred in all patients. In all the 39 cases where the breast dissector was used no pneumothorax was observed. In 34% of patients belonging to the control group (hand dissection) pneumothorax occurred which was treated successfully with a chest drain.

The operative time of the substernal route was 10±2 min with the breast dissector, and 25±3 with the conventional manual method. In those cases where a chest tube was necessary, the overall operative time

Discussion

The substernal route is a well-known procedure, even though some reports have focused on the pneumothorax complication during oesophageal reconstruction.7, 15, 16

Although other ancillary devices (e.g. a flexible board) have been reported for the dissection of the substernal tunnel,7 we introduced in chest surgery the use of a breast dissector largely known among plastic surgeons.

The breast dissector is firm, flat, with a dull edge; moreover, it is safe for blunt dissection of the substernal

References (16)

There are more references available in the full text version of this article.
View full text