Laparotomy after using the gastroepiploic artery graft: Retrogastric versus 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 the 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 of the liver. In our experience with 144 patients in whom the retrogastric route was used, 7 patients required an abdominal operation (2 had cholecystectomy, 2 had a partial colectomy, 1 had repair of paraesophageai hernia, and 2 had repair of abdominal wall complications). There was no need to dissect the RGEA graft in any of these patients. Results. There was no evidence of myocardial ischemia or other complications 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 route to minimize the risk of injury to the RGEA graft during a subsequent laparotomy.