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Ann Thorac Surg 1995;60:382-386
© 1995 The Society of Thoracic Surgeons

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Articles

Laparotomy after using the gastroepiploic artery graft: Retrogastric versus antegastric route

^a Departments of Cardiovascular Surgery and General Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
^b Department of Surgery, The Williamsport Hospital, Williamsport, Pennsylvania, USA

Accepted for publication March 9, 1995.

^* Address reprint requests to Dr Dietl, Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, PA 17822-1343.

Background.: Most cardiac surgeons prefer the antegastric route for the right gastroepiploic artery (RGEA) graft. When placed anterior to the stomach, the RGEA pedicle may adhere to the greater omentum, or to the anterior abdominal wall, and may be injured during future abdominal operations.

Methods.: To avoid this potentially lethal complication, we prefer to place the RGEA graft behind the stomach and the left lobe of the liver. In our experience with 144 patients in whom the retrogastric route was used, 7 patients required an abdominal operation (2 had cholecystectomy, 2 had a partial colectomy, 1 had repair of paraesophageai hernia, and 2 had repair of abdominal wall complications). There was no need to dissect the RGEA graft in any of these patients.

Results.: There was no evidence of myocardial ischemia or other complications during or after the operation in any patient.

Conclusions.: Based on our experience and the fact that any injury to the RGEA graft may have catastrophic consequences, we strongly advocate the retrogastric route to minimize the risk of injury to the RGEA graft during a subsequent laparotomy.

This article has been cited by other articles:

				T. Ohtsuka, Y. Suematsu, H. Kubota, S. Takamoto, and M. Makuuchi Salvage of right gastroepiploic artery graft before pancreatoduodenectomy J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 1013 - 1014. [Full Text] [PDF]

				C. A. Dietl Vascular reactivity of the gastroepiploic artery graft J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1568 - 1569. [Full Text]