LAPAROTOMY AFTER USING THE GASTROEPIPLOIC ARTERY GRAFT - RETROGASTRICVERSUS ANTEGASTRIC ROUTE

Background. Most cardiac surgeons prefer the antegastric route for the right gastroepiploic artery (RGEA) graft. When placed anterior to the stomach, the RGEA pedicle may adhere to the greater omentum, or to th e anterior abdominal wall, and may be injured during future abdominal operations. Methods. To avoid this potentially lethal complication, we prefer to place the RGEA graft behind the stomach and the left lobe o f the liver. In our exl,erience with 144 patients in whom the retrogas tric route was used, 7 patients required an abdominal operation (2 had cholecystectomy, 2 had a partial colectomy, 1 had repair of paraesoph ageal hernia, and 2 had repair of abdominal wall complications). There was no need to dissect the RGEA graft in any of these patients. Resul ts. There was no evidence of myocardial ischemia or other complication s during or after the operation in any patient. Conclusions. Based on our experience and the fact that any injury to the RGEA graft may have catastrophic consequences, we strongly advocate the retrogastric rout e to minimize the risk of injury to the RGEA graft during a subsequent laparotomy.