Greater omentum may be the problem, not part of the solution : vascular steal phenomenon

Oesophagectomy is a complex surgical procedure. Anastomotic and conduit complications, including anastomotic leak, ischaemic stricture, conduit ischaemia, and necrosis1 , may occur and these contribute to morbidity and mortality2 . To prepare a gastric conduit for reconstruction involves mobilization of the stomach, leaving the conduit vascularity totally dependent on the right gastroepiploic artery and vein. Should the omentum be preserved as a pedicle, it also utilizes the right gastroepiploic vessels as its solitary blood supply. This raises the question of whether its own blood supply needs can outweigh its supportive revascularization role, particularly if it is using the same arterial supply, which may not be beneficial to anastomoses. The objective of this pilot study was to demonstrate the vascular steal phenomenon effected by the greater omentum on the gastric conduit using indocyanine green (ICG) angiography.