Esophagocele due to two times caustic ingestions: resection through videothoracoscopy / Esofagocele por duas ingestões cáusticas: ressecção por videotoracoscopia

ABSTRACT BACKGROUND: Caustic ingestion is still a health problem of utmost importance in the West. In developing countries, this incident remains at increase and it is associated with unfavorable factors like social, economic, and educational handicaps, besides a lack of prevention. Esophagocele is a rare consequence of caustic ingestion. AIM: We aimed to describe a patient with multiple caustic ingestions who presented an esophagocele resected by videothoracoscopy. METHODS: A woman ingested caustic soda when she was only 17 years old in a suicidal attempt during a depressive crisis. Initially, she was submitted to a retrosternal esophagocoloplasty with the maintenance of her damaged esophagus. After 1 year of this first surgery, she ingested caustic soda again in a new suicidal attempt. Her transposed large bowel in the first surgery became narrow, being replaced in a second surgery by a retrosternal esophagogastroplasty. Still, at the second surgery, her damaged esophagus remained in its original position in the posterior mediastinum. However, after 5 years, she developed an esophagocele. RESULTS: The esophagocele was resected through videothoracoscopy in a prone position, employing four trocars. The postoperative was uneventful. CONCLUSION: Esophageal exclusion must always be recorded because esophagocele presents unspecific symptoms. The videothoracoscopy in a prone position is an excellent technical option to resect esophagoceles.

RESUMO RACIONAL: A ingestão de produtos cáusticos ainda é um problema de saúde de extrema importância no Ocidente. Nos países em desenvolvimento, este incidente continua em ascensão e está associada a fatores desfavoráveis como sociais, econômicos e educacionais, além da falta de prevenção. A esofagocele é uma consequência rara da ingestão de cáusticos. OBJETIVO: Nosso objetivo é descrever um paciente com múltiplas ingestões cáusticas que apresentou uma esofagocele ressecada por videotoracoscopia. MÉTODOS: Doente feminina que ingeriu soda cáustica com 17 anos de idade, como tentativa de suicídio, durante uma crise depressiva. Inicialmente, foi submetida a esofagocoloplastia retroesternal com manutenção do esôfago lesado. Após um ano desta primeira cirurgia, voltou a ingerir soda cáustica, em nova tentativa de suicídio. Seu intestino grosso transposto na primeira cirurgia tornou-se estenosado, sendo substituído em uma segunda cirurgia, por esofagogastroplastia retroesternal. Ainda assim, nesta segunda cirurgia, o esôfago lesado permaneceu em sua posição original no mediastino posterior. No entanto, após cinco anos, ela desenvolveu uma esofagocele. RESULTADOS: A esofagocele foi ressecada por videotoracoscopia, em decúbito ventral, empregando-se quatro trocartes. O pós-operatório transcorreu sem intercorrências. CONCLUSÕES: A exclusão esofágica deve ser sempre registrada, pois a esofagocele apresenta sintomas inespecíficos. A videotoracoscopia em posição prona é uma excelente opção técnica para ressecção de esofagoceles.

Experiences of esophageal replacement with ileocolon graft: a series of 34 cases / 中华外科杂志

Objective@#To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft.@*Methods@#Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed.@*Results@#The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017.@*Conclusion@#Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.

Early and late assessment of esophagocardioplasty in the surgical treatment of advanced recurrent megaesophagus / Avaliação precoce e tardia da esofagocardioplastia no tratamento cirúrgico do megaesôfago avançado e recidivado

ABSTRACT Background Since Chagas disease has esophageal manifestations with different degrees of involvement, the best surgical option is controversial, especially for patients with advanced chagasic megaesophagus and recurrent symptoms after previous treatment. Objective To assess the early and late outcomes of esophagocardioplasty in a series of patients with advanced recurrent chagasic megaesophagus. Methods This descriptive study included 19 older patients with recurrent megaesophagus grade III/IV and positive immunofluorescence for Chagas disease. They had undergone cardiomyotomy with anterior fundoplication a mean of 16.5 years ago. Serra-Doria esophagocardioplasty was selected to treat the recurrence. The patients were followed to assess postoperative and late complications and the incidence of symptom recurrence. Results In early assessment, five (26.3%) patients presented clinical complications. One (5.2%) patient had a gastrointestinal fistula secondary to esophagogastric anastomotic leak, which responded well to conservative treatment. In the one-year follow-up, 18 (94.7%) patients could swallow normally and had no vomiting. Three years after surgery, 10 (62.5%) of 16 patients could swallow normally, and 3 (19.3%) patients complained of vomiting. Five years after surgery, only 5 (38.4%) of 13 patients could swallow normally and 7 (53.8%) had vomiting. Conclusion Serra-Doria esophagocardioplasty for the treatment of advanced recurrent megaesophagus had mild postoperative complications and good success rate in the short-term follow-up. In the long-term follow-up, it proved to be a poor surgery choice because of the high incidence of symptom recurrence, compromising quality of life. This procedure should be indicated only for patients with advanced recurrent megaesophagus without clinical conditions to undergo esophageal resection.

RESUMO Contexto A doença de Chagas, por apresentar manifestações esofágicas com diferentes graus de acometimento, faz com que haja controvérsias quanto a melhor opção cirúrgica; principalmente para pacientes com megaesôfago chagásico avançado e com recidiva de sintomas após tratamento prévio. Objetivo Avaliar o resultado precoce e tardio da esofagocardioplastia em uma série de pacientes com megaesôfago chagásico avançado e recidivado. Métodos Estudo descritivo, com 19 pacientes idosos com megaesôfago Grau III/IV recidivado e com imunoflorescência positiva para doença de Chagas. A cirurgia prévia foi a cardiomiotomia com fundoplicatura anterior, com tempo médio de realização de 16,5 anos. A cirurgia de eleição para o tratamento da recidiva foi a esofagocardioplastia de Serra-Dória. Realizou-se avaliação precoce para estudar as complicações pós-operatórias e tardias, para avaliar a incidência de recidiva de sintomas. Resultados Na avaliação precoce, 5 (26,3%) pacientes apresentaram complicações clínicas. Um (5,2%) paciente apresentou fístula digestiva consequente a deiscência da anastomose esofagogástrica, mas com boa evolução com o tratamento conservador. Na avaliação de 1 ano de pós-operatório, 18 (94,7%) pacientes apresentavam deglutição normal e sem regurgitação. Com 3 anos de pós-operatório, de 16 pacientes analisados; 10 (62,5%) pacientes apresentavam deglutição normal e 3 (19,3%) se queixavam de regurgitação. Com 5 anos de pós-operatório, de 13 pacientes analisados; somente 5 (38,4%) apresentavam deglutição normal e 7 (53.8%) com regurgitação. Conclusão A esofagocardioplastia de Serra-Dória, no tratamento cirúrgico do megaesôfago avançado recidivado, apresentou complicações pós-operatórias de baixa morbidade e com boa resolutividade, na avaliação precoce. Na avaliação de longo prazo, demonstrou não ser um procedimento cirúrgico adequado, pela alta incidência de recidiva de sintomas, com comprometimento da qualidade de vida. Deve ser indicada somente em pacientes com doença avançada recidivada, sem condições clínicas de serem submetidas à ressecção esofágica.

Left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients / 中华老年医学杂志

Objective To investigate the application of left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients.Methods Clinical data of 83 patients with carcinoma in the middle or lower third of the esophagus aged ≥ 70 years who had undergone radical surgery at our hospital from January 2012 to September 2014 were collected.Patients were divided into two groups:the tubular gastrectomy group (n=38) which had undergone radical surgery through left transthoracic small incisions in combination with tubular gastrectomy and the stomach group (n =45) which had been treated with esophagectomy through conventional left posterolateral incisions and esophageal reconstruction with the remnant stomach.Clinical outcomes were compared between the two groups.Results Compared with the stomach group,operative blood loss [(204.3±75.4) ml vs.(258.4±80.2) ml,t=2.720,P＜0.05],chest drainage on the first and second postoperative day [(201.7±82.6) ml vs.(320.5±78.1) ml,(150.8±83.0) ml vs.(244.6 ± 81.2) ml,t =3.221 and 3.189,respectively,each P＜0.05],pain scores on the third postoperative day [(3.73 ± 1.02) vs.(0.24 ± 1.15),t =2.858,P ＜ 0.05],incidence of arrhythmia (13.2％ vs.33.3％,x2 =4.585,P＜0.05),pulmonary complications (18.4％ vs.46.7％,x2=7.353,P＜0.05) and incidences of gastroesophageal reflux and gastric emptying disorders (23.7％ vs.55.6％,0.0％ vs 11.1％,x2 =8.654 and 4.493,both P＜0.05) were less or lower in the tubular gastrectomy group.The two groups had no significant difference in operation time,length of hospital stay,anastomotic leakage,anastomotic stenosis or 1-year survival rate (each P ＞0.05).Conclusions Radical surgery with small incisions through the left chest combined with tubular gastrectomy shows highly favorable clinical outcomes in elderly patients with middle or lower esophageal cancer,and can significantly reduce surgical trauma,decrease postoperative complications,improve the quality of life,and help patients recover after surgery.

Effect of tubular stomach reconstruction on respiratory function and serum VEGF level in patients with esophageal cancer / 中国基层医药

Objective To study the effect of tubular stomach reconstruction on respiratory function and serum vascular endothelial growth factor(VEGF) level in patients with esophageal cancer.Methods 84 patients with esophagealcancer were randomIy divided into two groups.42 patients in the observation group were operated through tubular stomach reconstruction,while 42 patients in the control group were operated through full stomach and esophagus reconstruction of digestive tract.The respiratory function and serum VEGF were detected in all patients.Results The respiratory function was significantly declined after operation compared with before operation (P ＜ 0.05).The respiratory function was significantly improved postoperative two months compared with before operation (P ＜ 0.05,P ＜0.01),there was a significant difference between the two groups (P ＜ 0.05).Serum VEGF level was significantly decreased after operation in both two groups (P ＜ 0.0 1).Serum VEGF level of the observation group was significantly lower than that of the control group (P ＜ 0.05).Conclusion Tubular stomach reconstruction can improve respiratory function and prognosis of patients with esophageal cancer.

Clinical effects of gastrictube surgery for the treatment of esophageal carcinoma in elderly patients / 中华老年医学杂志

Objective To analyze clinical effects of gastric tube operation for treatment of esophageal cancer in elderly patients and evaluate its clinical efficacy and safety.Methods A total of 171 patients aged 60-72 years with esophageal cancer in our hospital were selected.They were randomly divided into treatment group and control group.Treatment group was treated with gastric tube operation,and control group was traditionally treated with complete replacement of esophagus with stomach.The quality of life,patient satisfaction and safety of operation were evaluated after 3 weeks,6 months and 12 months after operation,respectively.Results The operation for esophageal cancer in 171 patients were successful.At 3 weeks after the operation,the score of life quality in treatment group and control group were both low [(67.3±9.6) vs.(65.3±8.4)],and there were no significant differences between the two groups (P＞0.05).At 6 months and 12 months after operation,the scores of life quality were (89.2±8.3) and (90.3±9.6) in treatment group,and (66.5± 10.4) and (60.5 ± 11.2) in contol group,respectively.There were statistical differences between the two groups after 6 months and 12 months of operation (P＜0.05).The complication rate in treatment group (6.9％) was much lower than that in control group (30.6％),and there were significant differences between the two groups (x2 =18.43,P＜0.01).The patient satisfaction was in no differences between the two groups at 3 weeks after operation (P＞ 0.05),while there were statistically significant differences at 6 and 12 weeks after the operation (P＜0.05).Conclusions Gastric tube operation in treatment of elderly patients with esophageal cancer,can effectively improve the life quality,and prevent the occurrence of postoperative complications,which is worthy of clinical application.

Clinical outcome of transabdominally Heller-Dor operation for achalasia / 中华胸心血管外科杂志

Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.

Reconstruction of thoracic esophagus with pediculated diaphragmatic flap in dogs

PURPOSE: To verify whether pediculated diaphragmatic flaps were suitable to correct iatrogenic wounds in dog's esophagus injuries. METHODS: Seven dogs were submitted to resection of a segment of the esophagical wall, which was then corrected by suturing a pediculated diaphragm flap. Endoscopic evaluation of the esophagical wall was done forty days after the surgical procedure. RESULTS: Three animals died, one due to implant ischemia, caused by strangulation of the phrenic artery; other due to wound infection; and the last, due to mediastinitis. Scar retraction was observed, however, there was no stenosis, allowing the passage of a 9,8 mm probe with no difficulty. The limits between the implants and the native esophagus were indistinguishable, and the implant was covered by esophageal mucosa. CONCLUSION: The diaphragmatic flaps are suitable on the restoring of continuity in dog's thoracic esophagus.

OBJETIVO: Verificar se retalhos diafragmáticos pediculados seriam adequados para correção de defeitos iatrogênicos do esôfago do cão. MÉTODOS: Sete cães foram submetidos à ressecção de um segmento da parede esofágica, o qual foi corrigido por meio da sutura de um pedículo diafragmático pediculado. Um animal morreu devido à isquemia do implante causada pelo estrangulamento da artéria frênica, outro devido à infecção da ferida cutânea e outro devido a mediastinite. Aos 40 dias após o procedimento fez-se um exame endoscópico dos animais nos cães sobreviventes. RESULTADOS: Observou-se retração cicatricial sem repercutir em estenose, permitindo a passagem de sonda de 9,8 mm, sem dificuldade. Os limites entre os implantes e o esôfago nativo se apresentaram indistinguíveis e o implante estava recoberto por mucosa esofágica. CONCLUSÃO: Os retalhos diafragmáticos são adequados na restauração da continuidade do esôfago torácico do cão.

Reconstrução faringoesofágica com retalho microcirúrgico de jejuno após esofagectomia cervical / Faringoesophageal reconstruction with jejunum micro surgical flap after cervical esophagectomy: case report

A reconstrução faringoesofágica após a ressecção de carcinomas da laringe e faringe localmente avançados representa desafio ao cirurgião reconstrutor. Historicamente, a reconstrução faringoesofágica vem sendo realizada com retalhos locais ou à distância, necessitando de múltiplos procedimentos e hospitalizações prolongadas, além de resultados cirúrgicos pobres. O advento das técnicas reconstrutivas microcirúrgicas possibilitou aumento na qualidade de vida desses pacientes por meio de procedimento em tempo único e com baixas taxas de complicações. Neste artigo, os autores apresentam relato de caso de paciente submetido à reconstrução tardia de esôfago com retalho microcirúrgico de jejuno, após laringectomia total, faringectomia parcial e esofagectomia cervical e discutindo-se a técnica, fazendo-se uma breve revisão da literatura.

Reconstruction of the pharyngoesophagus after resection of locally advanced carcinoma of larynx and pharynx can be a difficult problem for the reconstructive surgeon. Historically, pharyngoesophagus reconstruction has been made with local or distant flaps, with multiple stages and long hospitalization, frequently with poor results. The approach with microsurgical techniques has enabled an increase in quality of life of these patients by means of a single stage procedure with low complication rates. In this article, the authors present a case report of a patient submitted to esophageal delayed reconstruction with jejunum microsurgical flap, after a total laringectomy, partial faringectomy and cervival esophagectomy, and discuss its technique and a brief literature review.

The result of esophagoplasty with transverse colon: 63 cases

Background: esophagoplasty with transverse colon is often used for benign esophageal diseases. In esophageal cancer, esophagoplasty with transverse colon is applied when the colon can not be used or in gastric bypass surgery, without removing tumor. Objectives: to evaluate the results of esophagoplasty with transverse colon in the treatment of some disorders of esophagus. Subjectives and Method: a retrospective descriptive study was carried out on 63 patients who with transverse colon from January 1982 to December 2006, including 46 cases of esophageal scar due to chemical induced esophageal burn, 14 cases of esophageal cancer, 1 case of esophageal narrow after failed surgery of cardia contraction, 1 case of 2nd stage esophagoplasty after surgery for esophageal injury and 1 case due to failure of surgery for congenital esophageal atrophy. Results: No postoperative mortality. Early postoperative complications included: 17 cases of anastomotic leakage (26.9%). No cases of colon graft necrosis. Narrow anastomotis occurred in 7 cases (11.1%). Inflammation of colon graft due to esophageal reflux in 3 cases (4.8%). The mean survival time of 11 esophageal cancer patients who had esophagoplasty, not removing tumors was 4.6 months (3-7 months). Conclussion: esophagoplastic surgery with transverse colon did not cause postoperative mortality, the rate of neck anastomotic leakage was relatively high and this rate has declined in recent years. After the surgery, the most patients had good functional results.

Replacement of partial esophageal defect with pulmonary tissue with vascular pedicle / 中华胸心血管外科杂志

Objective: The purpose of our experiment is to use new type esophageal prosthesis, which is pulmonary tissue with vascular pedicle, to repair the partial esophageal defect. Methods: Twelve adult mongrel dogs were used for the study. Middle lobar bronchus of right lung was ligated and incised, so the pulmonary tissue with vascular pedicle was made. A 4 cm long and 1/2～2/3 circled esophageal wall, and full-thickness defect was created. The defect was patched by pulmonary tissue with vascular pedicle. Results: Seven dogs were put to death at planned times after the reconstructive operation. One dog is still alive without any problems for more than 12 months. One dog survived 38 days and then died of chronic empyema. The other three dogs died of anastomotic leak at 5～7 days after operation. The living dogs could be fed orally at seventh day after operation. Epithelization was found in the luminal surface of the defect. Conclusion: It was feasible that the partial esophageal defect was replaced by pulmonary tissue with vascular pedicle.

Reconstructive operation with colon or stomach for scarred stricture after esophageal burns / 中华胸心血管外科杂志

Objective To summarize the experience and the outcome of the reconstructive operation with colon or stomach for scarred stricture after esophageal burns. Methods This retrospective report reviews the clinical history of reconstructive operation with colon or stomach for scarred stricture after esophageal burns. 74 cases underwent esophageal reconstruction by colon without resection of scarred esophagus, 26 cases esophagogastric reconstruction with resection of scarred esophagus. Results In the group reconstructed with colon there were 5 postoperative deaths, including mediastinal infection caused by necrosis of transposition colon in 2 cases. Other postoperative complications included cervical anastomotic leakage in 14 cases and anastomotic stenosis in 4 cases. In the group reconstructed with stomach, there was no operative death and only 2 anastomotic stenosis and one empyema occurred after operation. Conclusion The proximal esophageal scarred stricture beyond the lower edges of aortic arch could be replaced by colon bypass without resecting the scarred esophagus. The esophagogastrostomy could be performed after excising scarred esophagus with the anastomosis can be made below the aortic arch. The postoperative complications in the group of reconstruction with colon were higher than the group of reconstruction with stomach. Improvement in surgical technique may decrease the complication rate of reconstruction with colon.

The experimental study of the artificial esophagus composed of resorbable porcine thoracic aortas acellular matrix / 中华胸心血管外科杂志

Objective To investigate the feasability of resorbable porcine-derived, xenogeneic aortas acelullar tissue matrix (ACTM) to be used as scaffold for cervical esophageal defect repair in a dog model. Methods Esophageal segmental defect measuring 5cm in length were created by surgical resection in 6 mature Chinese mongrel health dogs, then the defect were repaired with aorta acelullar tissue matrix (ACTM). The animals were kept alive for periods. The healing process was observed. Results There no death after perioperative period, one dog had anastomotic leakage. one dog was died of esophagus rupture as the result of esophageal dilation. Submucosal tissue regeneration and abundant neovascularization were found at 2 weeks. The squamous epithelium covered the most part of grafts surface in dogs killed after 4 weeks. 12 weeks later the squamous epithelium comprising 8 to 12 layers, both esophageal glands and muscle tissue were found. The graft material itself was mostly absorbed and could not be identified by naked eyes in the dogs killed after 12 weeks. Conclusion ACTM show promise as an ideal treatment option for esophageal repair.

Primary Repair of Boerhaave's Syndrome / 대한흉부외과학회지

Boerhaave's syndrome has the worst prognosis of the esophageal perforation, despite the advancement in the treatment of esophageal perforation due to the development of ICU care and antibiotics. There were controversies in the treatment of esophageal perforation when diagnosed after 24hrs. From 1995 to 2000, we performed a buttressed primary repair and mediastinal drainage in 6 Boerhaave's syndrome patients among 13 esophageal perforation patients. Two patients died(33%). They died because of pneumonia, ARDS and sepsis on 38th, 39th post-operative day respectively. Two patients had leak at the site of repair which was treated completely with conservative treatment. We report on the result of a buttressed primary repair and mediastinal drainage for 6 Boerhavve's syndrome patients.

Tratamento cirúrgico das complicações da anastomose esôfago-visceral cervical / Surgical treatment of the complications of the cervical esophago visceral anastomosis

A anastomose esôfago-visceral cervical apresenta como complicações a fístula e a estenose, que podem necessitar de reintervenção cirúrgica para sua correção. Com o objetivo de avaliar as táticas para abordagem operatória dessas complicações e seus resultados, os autores estudaram retrospectivamente nove pacientes, que demandaram esta conduta, num período de 17 anos. Foram operadas duas fístulas e sete estenoses da anastomose esôfago-visceral cervical, sendo a via de acesso inicial a cervicotomia em todos ospacientes. Em quatro casos, houve necessidade de ampliação para esternotomia mediana total, que facilitousignificativamente a reconstrução, porém com mortalidade de 75%. As táticas adotadas foram a reanastomoseem cinco casos, a sutura do orifício da fístula em um caso e a plastia em três casos. A ressutura teve mau resultado. As plastias evoluíram satisfatoriamente, e os doentes submetidos a reanastomose sem ésternotomiatambém evoluíram satisfatoriamente. A plastia da anastomose demonstrou ser uma boa tática para o tratamento da estenose cervical, enquanto a reanastomose parece ter a melhor indicação nas fístulas, devendo-se evitar a esternotomia total mediana.

The esophago-visceral cervical anastomosis presents complications such as fistula and stenosis that mayneed surgical reintervention for it’s correction. The authors, with the objective of evaluating proceduresfor surgical approach and the results of these complications, have studied retrospectively 9 patients whom demanded this conduct in a 17-year period. Two fistulas and seven esophago-visceral cervical anastomosisstenosis were performed, being cervicotomy the initial access in all patients. In four cases there was a needto enlarge the access, achieved with a total median sternotomy, which made the reconstruction significantly easier, therefore there was 75% mortality. The tactics adopted were reanastomosis in 5 cases, suture of the fistula’s orifice in one case, and plasty in three. Ressuturing obtained bad results. The patients subbmited to plasties evoluted satisfactorily and patients submitted to reanastomosis without total median sternotomy also evoluted satisfactorily. Anastomosis plasty proved to be a good tactic for the treatment of cervicalstenosis, while reanastomosis seems to be a better indication for treatment of fistulas, being that total median sternotomy is avoided.

The experimental studies of cardioplasty and total fundoplication on dogs / 第三军医大学学报

The aims of this study are to obtain a suilablc condition for the cardioplasty with the fundoplication and an observation of the effect of the antircflux function following the operations. The results show that a suppcrting dcvicc of a round tube with 1 - 1.2 ctn diamcter is used as a guide to establish a good lovver esophageal sphinctcr(LES). The experimental ani-mais may survive very long. The pressure in the sphimcter is cvenly the same as that after the operation immediately. The gastroesophageal reflux is never occurred except intragastric pres-sure is the same as or higher than LES. The lower csophagcal high pressure zone formed is similar to the smooth muscle in the lower part of csophagus at the sile of opcralions . The new formed cardia plays an excellent role of anturc flux function . This report suggists that the cardioplasty with fundoplication is useful for the treatment of esophageal achalasia and somc other abdpminal disorders.