Stomach pull-up versus colon bypass as an esophageal substitute in treating post-corrosive stricture

Sixteen patients with corrosive esophageal stricture were included in this study. There were 9 females and 7 males. Their ages ranged from 10 to 22 years. Indications for surgery were too long strictures, too tight strictures, and multiple strictures with failure of endoscopic dilatation. In 9 patients [group I], colon was used as esophageal substitute [colon bypass in 7 patients and colon replacement in 2 patients]. For the other 7 patients [group II]. stomach pull-up was the technique adopted. Patients follow-up was achieved by upper gastrointestinal [GI] endoscopy, barium studies, 24 hours pH monitoring and manometric studies. Stomach pull-up surgery utilized shorter time and less blood units. There were no mortalities among both groups. The following complications were recorded: anastomotic leaks [3 in group I - 2 in group II], reflux symptoms [2 in group I - 2 in group II], and cervical anastomotic strictures [2 in group I - 1 in group II]. One patient in group II complained of dumping symptoms while one patient in group I suffered from recurrent food regurgitation. Most symptoms were treated medically except one patient on group I with persistent stricture which necessitated revision of neck anastomosis. Barium and manometric studies [done for 5 patients only] proved that thoracic-transposed stomach by time changed into a conduit rather than a reservoir with active peristalsis while colon transmitted foods and drinks by gravity with no evidence of any peristaltic waves. Two patients in group II had iron-deficiency anemia. Stomach proved to be a challenging esophageal substitute to colon graft in treating benign esophageal strictures. More long-term follow-up studies are required to assess the metabolic results

Effect of common bile duct ligation followed by biliary diversion on the portal blood pressure and liver architecture in rats

The aim of this work was to study the liver structure and portal hemodynamics in rats after various periods of biliary obstruction and after relief of the obstruction by biliary anastomosis and to determine whether portal hypertension may remain despite of the normal liver function and structure. The results showed that biliary obstruction for 14 and 28 days induced an increase of portal pressure [PP], wedge hepatic vein pressure [WHVP] and portal tract fibrosis. The longer the obstruction, the higher the pressures and extent of fibrosis. It was concluded that portal hypertension may arise very shortly after biliary obstruction in rats and that it may persist with a prolonged biliary obstruction despite of an efficient bile drainage

Enteral versus parenteral nutrition support following laparotomy in seriously traumatized patients

Polytraumatized patients are characterized by hypercatabolic states with great need for full nutrition for energy supply, host defence, and wound healing. This is a prospective randomized study including 30 seriously injured patients admitted to our hospitals between March 1996 and April 1998. We are comparing the efficacy of total parenteral nutrition [TPN] versus tube feeding jejunostomy. We started nutritional support immediately postoperatively. There were no significant differences between the two groups as regards age, sex, injury severity score [ISS], and mechanism of injury. Daily caloric intake, nitrogen intake, and nitrogen balance were statistically comparable in both groups. The results showed that pre-and post-nutrition weight, biochemical investigations and body parameters were comparable in both groups. Septic complications were lower in tube feeding jejunostomy patients, while abdominal complications were higher in them than TPN group. We suggest that early post-operative feeding jejunostomy is a reliable, safe, simple and cost effective method of nutrition for polytraumatized patients undergoing laparotomy