1. Roux-en-Y Diversion for Intractable Reflux After Esophagectomy
Xavier Benoit D'Journo, MD, Jocelyne Martin, MD, Louis Gaboury, MD, Pasquale Ferraro, MD, André Duranceau, MD 
The Annals of Thoracic Surgery 
Volume 86, Issue 5, Pages (November 2008)
DOI: /j.athoracsur
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Roux-en-Y reconstruction in patients with substernal transposition. (A) Esophagectomy with substernal reconstruction and left cervical anastomosis. The exposure is by a partial or complete sternotomy. The dissection locates the pyloroduodenal junction and care is taken to identify and preserve the right gastroepiploic blood supply to the stomach. (B) A suprapapillary closure and transection of the duodenum is achieved. The antrectomy is completed by progressive dissection of the distal third of the stomach close to its wall with ligation of antral vessels from the gastroepiploic artery. The jejunum is transected 15 cm distal to the ligament of Treitz to preserve the first mesenteric loop. Preparation for a Roux-en-Y reconstruction is completed. (C) The distal end of the transected jejunum is brought through the transverse mesocolon and anastomosed to the stomach as an end-to-side gastrojejunostomy. The jejunojejunostomy of the Roux-en-Y limb is completed 60-cm below the gastrojejunostomy.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Roux-en-Y reconstruction in patients with prevertebral transposition. (A) Esophagectomy with a prevertebral reconstruction and right chest anastomosis (Ivor-Lewis). The exposure is by laparotomy and transhiatal dissection. (B) Transection of the duodenum below the pylorus with a 60-mm linear stapler affords biliopancreatic diversion. Pylorectomy with distal antrectomy is completed. The jejunum is transected 15 cm below the ligament of Treitz. The distal end of the divided jejunum is brought through the transverse mesocolon, and the antrojejunostomy is created. (C) The 60-cm Roux-en-Y diversion is completed by the distal jejunojejunostomy.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions