A Simple and Reliable Procedure Modification for Inverting Stripping Resection of the Esophagus

Abstract

Introduction: Inverting stripping resection is a well-described method of esophageal surgery. Although the indications for this procedure have decreased due to the widespread of endoscopic mucosal resection and the advancement of thoracoscopic surgery, familiarity with this procedure is important for the esophageal surgeon. We herein describe the inverting stripping procedure using simple and reliable methods. Materials and Methods: Porcine esophagus was used. A model with a detached and non-detached site was made with a sponge, and stripping was performed. In our new technique, air was injected into the esophagus and stripping was performed. Clinically, the esophagus was examined from within the esophageal lumen using an endoscope. Results: The porcine esophagus was stacked on itself without inverting. By pulling the stripper further, the esophagus was drawn into the sponge and appeared on the caudal side of the sponge inverted. With air supply, the esophagus did not stack up and the stripping was smooth. Endoscopically, esophageal stump is sequentially inverted. Conclusion: During an inverting stripping resection, the esophagus is ultimately withdrawn into an invaginated state. However, this method can damage the esophagus. With our method, we can perform inverting stripping resection of the esophagus with minimal damage and resistance felt by the surgeon.