STEP 4Esophageal transection

The mucosal layer of the esophagus is completely divided, with the posterior muscular layer left intact (A-1). The posterior muscle layer is preserved to prevent twisting, stricture, and leakage. The divided esophageal varices should not be ligated, because ligation of the divided varices may cause postoperative stenosis.

Posterior mucosal layer is sutured using 4-0 or 5-0 Vicryl (A-2).

Anterior mucosal layer is sutured (A-3). About 50-70 interrupted sutures are placed in total, and the divided varices are occluded with sutures.

After the muscle layer of 4-0 Ti-Cron is completed, a nasogastric tube is left in the stomach (A-4).

Esophageal transection 2

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