comparison of the complications between two surgical techniques of esophageal cancer

Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it

Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group

Results: In a retrospective cohort study 100 patients entered the study with 59 male and 41 female and with a mean age 54.6 +/- 6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique [P=0.182] so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique [P=0.03] so there was a significant difference between the two groups

Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis

8-year experience of esophageal atresia repair in Sarvar children hospital [Mashhad- IRAN]

Esophageal atresia [EA] is a congenital anomaly treated by surgical reconstruction. Some early postoperative complications may be encountered we assessed complications following EA repair in a large series of neonates with EA / TEF and in hospital mortality among a large series of our cases. 243 patients with EA / TEF that were treated operatively in Sarvar Children's Hospital from 2002 to 2010 were studied. Early post-operative complications in the ICU and surgery ward until hospital discharge were assessed. Mean age was 3.4 +/- 2.76 days. Primary repair was performed in 83.5% Mean hospital stay was 12.5 +/- 12.81 days. Respiratory problems and food intolerance were the most common early complications. In-hospital mortality rate decreased significantly during the last 8 years [from 17.6% to 4.7%]. Acceptable results and a growing survival rate were observed in this series of patients and we anticipate better results with improvements in minimally invasive methods

[ role of thoracoscopy in diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal traumas]

Complications like chronic diaphragmatic hernia thoracoabdominal stab wound following conservative treatment, make it necessary to find a safe and exact diagnostic method. The aim of this work was to assess, accurate diagnostic value of thoracoscopy in occult diaphragmatic injuries in penetrating thoracoabdominal stab wound. In the present prospective study, from March 2005 to October 2007 at Ghaem, Emam Reza and Shahid Kamyab Hospitals of Mashhad University of Medical Sciences, thirty patients with penetrating thoracoabdominal injuries, with stable hemodynamic and no need to emergent exploration were evaluated. They underwent thoracoscopy to evaluate probable diaphragmatic injuries, which were repaired via thoracoscopy or laparatomy and all patients evaluated for chronic diaphragmatic hernia by CT-scan, 6 months later. Mean age was 26.2 years and M/F ratio was 5:1. In thoracoscopic evaluations five hidden diaphragmatic injuries [16.7%] were observed, that 3 cases [9.9%] were repaired through thoracoscopic approach and laparatomy was inevitable in 2 [6.6%] patients. Lung paranchymal laceration was seen in 2 patients [6.6%], repaired with thoracoscopy and intra abdominal injury was seen in 1 patient [3.3%], repaired with loparatomy. No complication reported after thoracoscopy and there was no evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scan performed 6 months later. In this study, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries was 100%. Because of high diagnostic accuracy rate, and minimal invasively diagnostic and treatment ability of thoracoscopy, this diagnostic method in all clinically stable patients with penetrating thoracoabdominal stab wound is recommended