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

Invited Commentary

Invited Commentary

Hisayoshi Suma, MD

Cattedra di Cardiochirurgia, Università Cattolica del Sacro Cuore, Largo F, Vito, Rome, Italy 1-00168

See also page 382.

In the 10-year history of the right gastroepiploic artery (GEA) graft, management of the patent in situ GEA graft at future abdominal operation has been a major concern. Doctor Dietl and associates now shed light on the way to solve this difficult problem. They report 6 abdominal operations (2 for abdominal wall dehiscence, 2 for cholecystitis, and 1 each for hiatal hernia and colon cancer) among 140 patients with GEA graft. They did not find any trouble at the time of abdominal operation because the GEA graft was located behind the stomach and the liver. As they mentioned, most cardiac surgeons who use the GEA graft preferentially use the anterior route technique locating the graft in front of the stomach and the liver because it is easy to handle and easy to check the bleeding or twisting of the pedicle even after the GEA--coronary anastomosis has been completed.

In my experience with the GEA graft in 565 patients, I have used the anterior route in all cases. The GEA is long enough to reach the posterior side of the heart with the anterior route. There were 6 patients who subsequently underwent abdominal operation in my series, 3 for cholecystitis and 1 each for gastric cancer, colon cancer, and ventral hernia. There was neither death nor myocardial infarction during successful abdominal operation, whereas 1 patient showed hemodynamic instability during cholecystectomy.

I agree with Dietl and associates' conclusion that the posterior route might be more protective for the GEA pedicle at future laparotomy. However, comparison of the graft patency between the anterior and posterior routes, suitable target area for the posterior route, and possible complications such as diaphragmatic hernia should be clarified. Finally, the patients with a GEA graft always should be well informed that one of their lifelines is in the abdomen.


Related Article

Laparotomy After Using the Gastroepiploic Artery Graft: Retrogastric Versus Antegastric Route
Charles A. Dietl, John E. Deitrick, John C. West, and Timothy J. Pagana
Ann. Thorac. Surg. 1995 60: 382-385. [Abstract] [Full Text]




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