Use of omentum for mediastinal tracheostomy after total laryngoesophagectomy Yoshiyuki Kuwabara, MD, Atsushi Sato, MD, Masami Mitani, MD, Noriyuki Shinoda,

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Use of omentum for mediastinal tracheostomy after total laryngoesophagectomy Yoshiyuki Kuwabara, MD, Atsushi Sato, MD, Masami Mitani, MD, Noriyuki Shinoda, MD, Koji Hattori, MD, Tomotaka Suzuki, MD, Yoshitaka Fujii, MD The Annals of Thoracic Surgery Volume 71, Issue 2, Pages 409-413 (February 2001) DOI: 10.1016/S0003-4975(00)02228-1

Fig 1 Skin incision and resection of upper anterior chest wall. A large U-shaped and midline incision (single line). The medial thirds of the clavicles, medial segments of the first and second costal cartilages, and the sternum to the level of the upper edge of the third rib are removed (double line). The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)

Fig 2 Gastric tube (3 to 5 cm wide) with the entire omentum attached is made by sequential applications of 5-cm gastrointestinal anastomotic stapler along the lesser curvature, leaving the first 2 to 3 branches of the right gastric artery. The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)

Fig 3 This gastric tube with the entire omentum is placed into the neck through the posterior mediastinum. The pharyngogastric anastomosis is performed with an end-to-end anastomotic stapler (size 31 mm). The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)

Fig 4 The trachea is transposed inferiorly and between the superior vena cava and aortic arch. The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)

Fig 5 The omentum is divided in two; the lower half is placed around the trachea. The other half is spread on the neck wound to cover the main arteries and anastomosis and to fill the defect. The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)

Fig 6 A patient 1 month after the operation using this method, showing the finished appearance of the anterior chest wall. The Annals of Thoracic Surgery 2001 71, 409-413DOI: (10.1016/S0003-4975(00)02228-1)