Exploration of esophagojejunostomy after totally laparoscopic total gastrectomy / 中华胃肠外科杂志

The advantages of lymph node dissection through total laparoscopic total gastrectomy (TLTG) seem to be more and more accepted by the academic community. However, reconstruction of digestive tract is challenging and remains a focus of debate and research. Which way is better for esophagojejunostomy, circular stapler or linear stapler,remains to be answered. The authors believe that, under the conditions of existing anastomosis instruments, using of linear stapler for esophagojejunal side-to-side anastomosis may be the most common choice, but it must be used with strict indications, because there are still many problems to be solved. It is believed that with the breakthrough in the development of the circular stapler suitable for esophagojejunostomy in TLTG, the application of circular stapler for digestive tract reconstruction will become the mainstream again in future. Thus, the current routine clinical practice of TLTG should be cautious and the surgical indications should be strictly evaluated.

Resultados de la cirugía de sustitución esofágica con tubo gástrico invertido vía ascenso retroesternal en dos hospitales pediátricos / Results of esophageal substitution surgery with inverted gastric tube via retrosternal lift

Resumen Objetivo: Describir resultados de la cirugía de sustitución esofágica con tubo gástrico invertido, vía ascenso retroesternal en dos hospitales pediátricos durante el período marzo 2015 a marzo 2018. Materiales y Método: Un estudio observacional, transversal, con recolección de datos retrospectivo, donde se incluyeron todos los expedientes de pacientes que presentaban patología del esófago por causa adquirida o congénita que fueron operados de sustitución esofágica con tubo gástrico invertido en dos hospitales pediátricos durante 3 años. Resultados: Encontramos 29 niños sometidos a sustitución esofágica, de los cuales 27 cumplieron criterios de inclusión. La edad comprendida entre 2 y 17 años. El 63% corresponde al sexo femenino. La causa más frecuente de sustitución esofágica es por estenosis esofágica por ingesta caustica (92,59%). El 70% presentó algún tipo de complicación luego de la cirugía. La fístula esofagocutánea es la complicación principal con 33,33%. La permanencia en la unidad de cuidados intensivos es menor de 24 horas en un 74% de los niños. Se inicia la vía oral en casi la mitad de casos entre los 10-12 días de posquirúrgico, la estancia hospitalaria es en promedio 18,5 días. La mortalidad es 3,7%. Conclusión: La sustitución esofágica por tubo gástrico invertido vía ascenso retroesternal, es una técnica comparable en resultados a la interposición de colón. Para los autores, el estómago es un órgano ideal para realizar la reconstrucción esofágica, y sus complicaciones son manejables.

Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusión: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable.

Comparación de vía mediastinal posterior versus vía retroesternal para el reemplazo de esófago con ascenso gástrico parcial. Motivo de un cambio de estrategia / Comparison of posterior mediastinal versus retrosternal route for esophageal replacement with partial gastric pull-up. Rationale for a change in strategy

Introducción: existen dos rutas para realizar el reemplazo de esófago (RE), la retroesternal (RRE) y la mediastinal posterior (RMP). El objetivo del estudio es comparar los pacientes que recibieron un ascenso gástrico parcial empleando estas dos rutas. Material y métodos: Se revisaron las historias clínicas de 51 pacientes con ascenso gástrico parcial, en 27 años en el Hospital Garrahan. Se utilizó la vía RRE en 25 casos y la RMP en 26. Fueron comparados los datos epidemiológicos de los grupos y las variables para valorar la dificultad del acto quirúrgico, evolución inmediata y alejada. El estudio es comparativo, retro-prospectivo y longitudinal. Resultados: las características generales de los pacientes fueron similares. Los que recibieron el ascenso gástrico por vía RMP presentaron una menor incidencia de dehiscencia (p=0,017), de enfermedad por reflujo gastroesofágico (ERGE) (p=0,001) y de dumping (p=0,0001). No hubo diferencias estadísticamente significativas entre los dos grupos al comparar la duración del procedimiento, días de internación total y en Unidad de Cuidados Intensivos (UCI), días de permanencia en asistencia respiratoria mecánica (ARM), inicio de alimentación oral y estenosis de la anastomosis. Se observó una tendencia clínicamente relevante, que no alcanzó significancia estadística en las complicaciones intraquirúrgicas y número de dilataciones postoperatorias. No hubo necrosis del ascenso. Fallecieron 2 pacientes. Conclusiones: considerando la menor incidencia de dehiscencia, ERGE y dumping reemplazados por RMP, elegimos a ésta como nuestra primera opción para el reemplazo esofágico en la infancia (AU)

Introduction: The two routes for esophageal replacement (ER) are retrosternal (RRE) and posterior mediastinal (PMR). The aim of the study was to compare patients who received a partial gastric pull-up using either of these two routes. Material and methods: The clinical records of 51 patients who underwent partial gastric pull-up over 27 years at the Garrahan Hospital were reviewed. The RRE route was used in 25 and the RMP in 26 cases. The epidemiological data of the groups and the variables to evaluate the complexity of the surgical procedure, and shortand long-term outcome were compared. A comparative, retroprospective, and longitudinal study was conducted. Results: the general characteristics of the patients were similar. Those who underwent gastric pull-up via PMR had a lower incidence of dehiscence (p=0.017), gastroesophageal reflux disease (GERD) (p=0.001), and dumping (p=0.0001). No statistically significant differences were found between the two groups when comparing the duration of the procedure, days of total hospital and intensive care unit (ICU) stay, days on mechanical ventilation (MV), initiation of oral feeding and stenosis of the anastomosis. A clinically relevant trend, which did not reach statistical significance, was observed in intraoperative complications and number of postoperative dilatations. There was no necrosis of the pull-up. Two patients died. Conclusions: considering the lower incidence of dehiscence, GERD, and dumping associated with PMR, this was our first choice for esophageal replacement in infancy (AU)

Reversión del bypass gástrico: indicaciones y resultados quirúrgicos / Gastric bypass reversal: surgical indications and results

Resumen Introducción: Debido a su eficacia en el tratamiento de la obesidad mórbida, el bypass gástrico (BPG) sigue siendo una intervención realizada frecuentemente. Sin embargo, un grupo reducido de pacientes puede desarrollar complicaciones nutricionales y metabólicas que no logran controlarse con un tratamiento médico óptimo. En estos casos, puede ser necesario reestablecer la continuidad del tracto gastrointestinal por medio de la reversión del BPG (R-BPG). Objetivo: Presentar las indicaciones y resultados obtenidos en una serie de pacientes sometidos a una R-BPG. Materiales y Método: Identificación y evaluación retrospectiva de todos los pacientes sometidos a una R-BPG en nuestra institución de manera consecutiva. Se registraron las características demográficas y antropométricas de la cirugía original y al momento de la reversión. Las complicaciones se registraron de acuerdo con la clasificación de Clavien-Dindo. Resultados: Se identificaron 7 pacientes en los cuales se realizó una R-BPG. En 2 casos la reversión fue por síndrome de intestino corto, en 3 casos por hipoglicemias severas refractarias a manejo médico y en 2 casos por diarrea crónica. La mediana de edad al momento de la reversión fue de 55 años. La mediana de tiempo desde la cirugía original hasta el momento de la reversión fue de 77 meses. La mediana de estadía hospitalaria fue de 6 días. No hubo complicaciones Clavien-Dindo ≥ III. La R-BPG logró revertir en todos los casos las complicaciones nutricionales y metabólicas. Conclusión: La restauración de la continuidad del tracto gastrointestinal permite el control de las complicaciones nutricionales y metabólicas.

Introduction: Due to its efficacy in the treatment of morbid obesity, roux-en-y gastric bypass (RYGB) continues to be a frequently performed intervention. However, a small group of patients may develop nutritional and metabolic complications that cannot be controlled with optimal medical treatment. In these cases, it may be necessary to reestablish the continuity of the gastrointestinal tract by reversing the RYGB (R-RYGB). Aim: To present the indications and results obtained in a series of patients who underwent to R-RYGB. Materials and Method: Identification and retrospective evaluation of all patients who underwent consecutive R-RYGB in our institution. Demographic and anthropometric characteristics of the original surgery and at the time of the reversal were recorded. Complications were classified according to Clavien-Dindo classification. Results: Seven patients were identified in whom an R-RYGB was performed. In 2 cases the reversal was due to short bowel syndrome, in 3 cases due to severe hypoglycemia refractory to medical treatment and in 2 cases due to chronic diarrhea. The median age at the time of the reversal was 55 years. The median time from primary surgery to reversal was 77 months. The median hospital stay was 6 days. There were no Clavien-Dindo complications ≥ III. The R-RYGB was able to reverse nutritional and metabolic complications in all cases. Conclusion: Restoring the continuity of the gastrointestinal tract allows control of nutritional and metabolic complications.

Application of gastric tube esophagoplasty to complicated diseases of esophagus in children / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of applying gastric tube esophagoplasty for complicated diseases of esophagus in children and the short-middle-term efficacy.</p><p><b>METHODS</b>A retrospective and observational case series study was performed.</p><p><b>INCLUSION CRITERIA</b>(1) burn length of esophagus > 2 cm, multisegmental or extensive esophageal scar stenosis, and about 6 months after burn; (2) longitudinal diameter of esophageal tumor > 2 cm, or esophagus considered as impossible to reserve;(3) Severe esophageal fistula with diameter > 2 cm, or relapse again after ≥3 times of repair; (4) Tracheal cartilaginous esophageal heterotopia with a length of >2 cm or no end to end anastomosis after removal of the esophageal lesion.</p><p><b>EXCLUSION CRITERIA</b>patients with severe cardiopulmonary insufficiency, or poor prognosis of gastric primary disease; the gastric volume did not allow long enough gastric tube; the parents did not accept the surgery. According to above criteria, 36 children with complicated diseases of esophagus who underwent gastric tube esophagoplasty at Department of Thoracic Surgery, Guangzhou Women and Children's Medical Center from March 2010 to June 2017 were enrolled into this study. Among 36 children, 27 were with corrosive strictures of esophagus, 5 with esophageal tumor, 3 with severe esophageal fistula, and 1 with tracheal cartilaginous esophageal heterotopia. Above-mentioned 27 cases with corrosive strictures of esophagus underwent gastric tube esophagoplasty via retrosternal route with preservation of the original esophagus. The other 9 cases underwent resection for esophageal lesion and gastric tube esophagoplasty via prevertebral route. The construction of gastric tube was as follows: the stomach was cut along the lesser curvature from pylorus to cardia and fundus of stomach with stapler, making the diameter of the gastric tube equal to pylorus. Operative time, intra-operative bleeding, time of mechanical ventilation, anastomotic leakage, anastomotic stricture were observed. The postoperative short-middle-term growth presentation of children was evaluated according to CDC 2000 children growth evaluation table(2 to 20 years).</p><p><b>RESULTS</b>All the 36 children survived their operations successfully. Nine cases underwent esophagectomy for lesion esophagus and the other 27 cases received preservation of original esophagus. Average time of postoperative mechanical ventilation was 8 (4-20) hours. Three cases developed anastomotic leakage and were healed after one week. Eight cases developed anastomotic stricture and resumed normal diet after balloon expansion. The patients were followed up from 6 months to 7 years. Five cases were found to have esophageal cyst 4-8 months after the operation, and received resection. One children with infantile esophageal fibrosarcoma recurred 3 weeks after the operation and died 2 weeks later because the family abandoned the treatment. The quality of life of 35 cases was improved significantly. Short-middle-term body height and weight in 85.7%(30/35) children met basically the criteria of CDC 2000 children growth evaluation table.</p><p><b>CONCLUSION</b>Gastric tube esophagoplasty can effectively treat the children with complicated esophagus diseases with good short-middle-term efficacy, and is a recommended esophageal replacement surgery.</p>

Application of gastroepiploic tunnel esophagogastrostomy in minimally invasive esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.</p><p><b>METHODS</b>Clinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.</p><p><b>RESULTS</b>All the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).</p><p><b>CONCLUSION</b>The gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.</p>

Experiencias en la sustitución esofágica con colon izquierdo retroesternal antiperistáltico / Experiences accumulated in the esophageal replacement with left antiperistaltic retrosternal colon

INTRODUCCIÓN: la necesidad de reemplazo esofágico en nuestro medio continúa siendo uno de las tareas más difíciles para los cirujanos. Han sido muchas las técnicas y los elementos utilizados para la sustitución esofágica a través del tiempo, y también las disyuntivas entre cuál es la más fisiológica para el paciente. OBJETIVO: nos proponemos presentar nuestra experiencia de 15 años de trabajo, utilizando la esofagocoloplastia con colon izquierdo retroesternal y antiperistáltico, enfatizando los detalles de la técnica y los resultados posoperatorios. MÉTODOS: se analizan las estadísticas correspondientes a 15 años de trabajo en el Hospital Pediátrico Docente "Juan Manuel Márquez", con un total de 52 pacientes, mostrando los parámetros de edad, sexo, causas de la sustitución, técnica quirúrgica, complicaciones posoperatorias y mortalidad. RESULTADOS: la causa más frecuente de sustitución esofágica fue la estenosis por cáustico. La complicación posoperatoria de mayor incidencia fue la fístula salival, y existió una necrosis aséptica del injerto que conllevó a un segundo tiempo operatorio, con tubo gástrico. Hubo un fallecido por sepsis nosocomial. CONCLUSIONES: las complicaciones posoperatorias fueron mínimas, y solo en un caso se realizó un segundo tiempo quirúrgico utilizando tubo gástrico. Se considera esta técnica una alternativa quirúrgica de fácil realización, y cuando se siguen los cuidados técnicos adecuados, las complicaciones son mínimas y los resultados óptimos.

INTRODUCTION: the need for esophageal replacement in our context remains one of the most difficult tasks for surgeons. There have been a number of techniques and elements for esophageal replacement in the course of time and also various dilemmas about the most physiological ones for the patient. OBJECTIVE: to show our experience of 15 years in the use of esophagocoloplasty with left antiperistaltic retrosternal colon, putting emphasis on the details of the technique and the postoperative results. METHODS: an analysis was performed of statistics for 52 patients cared for at "Juan Manuel Márquez" Children's University Hospital during a 15 years' period. The variables considered were age, sex, causes of replacement, surgical technique, postoperative complications and mortality. RESULTS: the most frequent cause of esophageal replacement was caustic stenosis of the esophagus. The main postoperative complication was salivary fistula. There was also aseptic necrosis of the graft that led to reoperation with use of a gastric tube. One child died from nosocomial sepsis. CONCLUSIONS: postoperative complications were minimal and just one patient was reoperated, with use of a gastric tube. It is considered that this technique is an easy-to-perform surgical option and that the complications are minimal and the results are optimal whenever the adequate technical guidelines are followed and complied with.

One case of esophageal carcinoma defect after operation for repair with platysma myocutaneous flap / 临床耳鼻咽喉头颈外科杂志

Cervical esophageal carcinoma is rare, the lack of early clinical manifestations, early diagnosis is difficult, easily missed or misdiagnosed, especially at present for the method of repairing defect of cervical esophagus cancer after operation. In many mainstream, the repair methods with free jejunum, gastric pull up, and anterolateral thigh flap freeforearm flap. We used the platysma skin flap to repair of cervical esophagus defect which is worthy of reference,report as follows now.

Recent advances of anastomosis techniques of esophagojejunostomy after laparoscopic totally gastrectomy in gastric tumor / 中华胃肠外科杂志

The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique, the transorally inserted anvil(OrVil(TM)) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.

Free jejunum for circumferential hypopharynx and cervical esophagus reconstruction / 中华胃肠外科杂志

Free jejunum has always been a good choice for circumferential hypopharynx and cervical esophagus reconstruction with a low complication rate. Although more and more flaps were used in recent years, free jejunum is still considered as the first choice for such defect.

Donor site selection and clinical evaluation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series.@*METHOD@#Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed.@*RESULT@#Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively.@*CONCLUSION@#Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.

Clinical application of reverse puncture device(RPD) in laparascopic esophagogastrectomy (esophagojejunostomy): a report of 18 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>The authors report the newly developed reconstruction technique after laparoscopic total gastrectomy (LTG) or laparoscopic distal gastrectomy (LDG): intracorporeal circular stapling esophagojejunostomy(esophagojejunostomy) using the reverse puncture device(RPD).</p><p><b>METHODS</b>After LTG or LDG, The anvil is then transorally inserted into the esophagus by using the RPD system. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an Echelon.</p><p><b>RESULTS</b>There was no intraoperative complication or conversion to open surgery, the mean operation time was 155 min and blood loss was 75 ml. Postoperative fluorography revealed no anastomosis leakage or stenosis Patients resumed an oral liquid diet on postoperative day 2, and discharged at day 8.</p><p><b>CONCLUSIONS</b>We have successfully performed LTG or LDG, reconstruction using our technique in 18 patients without any anastomosis complications. We believe that our procedure is a safe and reliable reconstruction method, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis is often difficult.</p>

Preliminary study on gastric tube esophagoplasty for corrosive strictures of the esophagus in children / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of gastric tube esophagoplasty for complicated corrosive stricture of the esophagus in children.</p><p><b>METHODS</b>A retrospective analysis was performed to study 7 patients with complicated corrosive stricture of the esophagus who were treated with gastric tube esophagoplasty via retrosternal route between March 2010 and October 2011.</p><p><b>RESULTS</b>Three patients had a stricture longer than 2.5 cm, and 4 patients had more than one stricture. All the operations went well. The average time for mechanical ventilation postoperatively was 6 hours. No patients showed insufficient ventilation after withdraw of ventilator. There was 1 patient developed anastomotic leak which was healed a week later. One patient had anastomotic leak with pyloric obstruction, and the leak was healed 3 weeks after intraoperative placement of duodenal feeding tube and pyloric obstruction became patent 4 weeks later. There were 2 patients developed anastomotic stricture and they resumed normal diet after balloon dilatation. The average follow-up duration was 10.5 months. The quality of life was improved and no other complications were found.</p><p><b>CONCLUSION</b>Gastric tube esophagoplasty is a effective alternative for complicated corrosive stricture of the esophagus and the short-term outcomes are favorable.</p>

Surgical treatment for severe stenosis of esophageal access / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the surgical management for the severe stenosis of peripheral esophageal access.@*METHOD@#Twenty-three patients who underwent severe stenosis of peripheral esophageal access from 2000 to 2009, were retrospectively reviewed. The surgical plan was selected by considering the stage of stenosis, dilatation, reconstruction of hypopharynx, oesophagus or larynx.@*RESULT@#Twenty-two patients resumed a normal oral diet and 21 cases succeeded in decannulation, no stenosis recurred after a 1-9 years follow-up.@*CONCLUSION@#The severe stenosis of peripheral esophageal access can get good results when the appropriate surgical plan were choice.

Pharyngogastric or pharyngocolonic anastomosis in esophageal reconstruction for hypopharyngeal cancer or esophageal disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the surgical indications and postoperative morbidity of pharyngogastric anastomosis or pharyngocolonic anastomosis in esophageal reconstruction for advanced hypopharyngeal and cervical esophageal neoplasms or diffuse corrosive hypopharyngoesophageal stricture.@*METHOD@#Retrospectively analysis the experience and results of 52 patients undergoing esophageal reconstruction with pharyngogastric anastomosis and 66 patients with pharyngocolonic anastomosis. In the group of neoplasms, total esophagectomy with pharyngogastric anastomoses in 52 cases and with pharyngo-colonic anastomosis in 35 cases. Thirty-one cases with diffuse corrosive hypopharyngoesophageal stricture were treated by pharyngo-colonic anastomosis without resection of the strictured intrathoracic esophagus.@*RESULT@#In the group of neoplasm E, preservation of laryngeal functions in pharyngogastric anastomoses was performed in 28/52 cases and that of in pharyngo-colonic anastomosis was in 18/35 cases. There was no significant difference in preservation of laryngeal functions between two groups (P > 0.05). Pharyngocutaneous fistula was happened in 23 patients which significant higher in the group of pharyngocolonic anastomosis (17/66 cases) than that of pharynogogastric anasromoses (5/52 cases) (P < 0.05). Gastric reflux was presented in 19 cases and there was significant higher in pharyngogastric anastomoses (16/52 cases) than that of (3/66 cases) (P < 0.05).@*CONCLUSION@#Substitution of esophagus with stomach or colon can completely removed the neoplasms of hypopharynx or cervical esophagus and preserved laryngeal functions in selected patients. But gastric reflux is a challenging reconstructive problem in pharyngogastric anastomosis. Pharyngocolonic anastomosis should take into consideration to patients with extensive neoplasms and diffuse corrosive stricture or probably preserved the laryngeal functions. However, the swallow function is weak and the incidence of pharyngocolonic fistula is higher than that of pharyngogastric anastomosis.

Effect of hyperbaric oxygen therapy on esophagojejunal anastomosis healing in rats / O efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esofagojejunal em ratos

PURPOSE: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. METHODS: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student's "t" test was used. A value of p<0.05 was considered significant. RESULTS: There was a 20 percent mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. CONCLUSION: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis.

OBJETIVO: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. MÉTODOS: 40 ratos Wistar, adultos machos, pesando entre 322g e 506g, foram divididos aleatoriamente em dois grupos. No grupo A (grupo controle) 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram gastrectomizados e receberam tratamento pós-operatório com oxigênio hiperbárico, 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia pós-operatório e avaliados de acordo com as seguintes variáveis: a) presença de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal pela medida da força de ruptura à tração na linha da sutura conforme Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste "t" de Student, considerando-se como significativo o valor de p=0.05. RESULTADOS: A mortalidade foi de 20 por cento. Morreram cinco ratos do grupo A e tres do grupo B (p= N.S.). Ocorreu uma fístula anastomótica em cada grupo não relacionadas a óbito. A medida da força de ruptura à tração na linha da sutura (p= 0.528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p= 0.89) não mostrou diferença estatisticamente significativa entre os grupos A e B. CONCLUSÃO: A oxigenoterapia hiperbárica não interferiu no processo de cicatrização da anastomose esôfagojejunal.

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.

Observation on the long-term complications after esophageal replacement with colon / 中华外科杂志

<p><b>OBJECTIVE</b>To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease.</p><p><b>METHODS</b>To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form.</p><p><b>RESULTS</b>Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously.</p><p><b>CONCLUSIONS</b>The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.</p>