Laparoscopic Postlethwait procedure

This surgical procedure, initially described in 1979 by Postlethwait, is usually carried out to bypass either an unresectable esophageal cancer or after esophageal stenosis due to caustic ingestion, using the greater gastric curvature vascularized by the right gastroepiploic artery1. In this video, an isoperistaltic gastric tube (Postlethwait technique) to bypass an esophageal stricture was performed in a 60-year-old female patient, several years after ingestion of a caustic agent with failed endoscopic management. This video shows the different steps necessary to follow to perform this surgical procedure laparoscopically. The gastric mobilization was first performed by freeing the greater gastric curvature with dissection of the gastroepiploic ligament. Care was taken to not injure the right gastroepiploic artery because this artery remained the only vascular supply of the gastric tube. A Kocher maneuver was then performed to allow tension free mobilization of the stomach. The gastric tube was created (extracorporeally after enlarging the umbilical port) from the greater gastric curvature using an intraluminal stapler to transfix the stomach few centimeters above the pyloric sphincter (Fig. 1). Intracorporeally, a linear laparoscopic stapler was introduced into this ring created, and division of the stomach following the greater gastric curvature was created. Then, a 5 cm horizontal dissection plane was performed just below the xiphoid process to create the retrosternal tunnel, large enough to allow the passage of the gastric tube (Fig. 2). Gastric tube ascension was performed