Impact of gastric tube diameter on upper mediastinal anatomy after transhiatal esophagectomy

The most common means of reconstructing the esophagus in patients undergoing transhiatal esophagectomy is by passing the stomach through the esophageal bed into the neck, where an esophagogastric anastomosis is fashioned. A number of factors need to be considered in mobilizing the stomach for transhiatal esophageal reconstruction: the stomach tube must have adequate blood supply and be wide enough to permit passage of solid food and yet narrow enough to facilitate emptying and to fit through the limited space of the upper mediastinum. The construction of a non-reversed, greater curvature gastric tube of approximately 4-5 cm diameter, supplied by the right gastroepiploic vessels, appears to accomplish all of these goals.