Harvest of a pedicled omental flap preserving the right gastroepiploic artery for gastric conduit reconstruction in multistage surgery for aortoesophageal fistula.

Aortoesophageal fistula is a rare but highly fatal condition. Thoracic endovascular aortic repair has led to improved early outcomes. However, subsequent aortic replacement, esophagectomy, and gastrointestinal reconstruction are required to achieve long-term survival. Conventional pedicled flaps using both gastroepiploic arteries can prevent gastric conduit reconstruction, requiring small or large intestinal substitutes associated with greater surgical invasiveness. We developed the pedicled omental flap technique preserving the right gastroepiploic artery, which enabled simultaneous gastric conduit preparation and omental harvest in a multistage surgery. After a specific interval following esophagectomy, the omental flap was mobilized while preserving right gastroepiploic perfusion, and a gastric conduit was created. Both were evaluated via indocyanine green imaging. The omental flap was delivered into the thoracic cavity for later graft coverage. Meanwhile, the gastric conduit was left in situ for delayed reconstruction. This method reduced invasiveness and facilitated staged treatment of aortoesophageal fistula with improved surgical flexibility.