RESUMO
Objective To investigate the effect of great omentum combined with medical obturation glue on preventing thoracic cavity anastomotic leakage.Methods From August 2008 to September 2012,560 patients with esophageal gastric cardial carcinoma were enrolled and divided into two groups:the regular group (n =280) and the experimental group (n =280).In the regular group,anastomosis was reinforced with interrupted mattress sutures after esophageal gastric anastomosis was stapled.In the experimental group,anastomosis was covered with great omentum and medical obturation glue was sprayed to conglutinate after reinforced with interrupted mattress sutures.After that,gastric corpus was fixed upon the thoracic aorta and posterior chest wall.The clinical effects of the two groups were compared.Results Intrathoracic anastomotic leakage occurred in 8 cases (2.86％(8/280)) of the regular group,including 7 cases with symptomatic leakage and 1 case with asymptomatic loculate leakage.Seven patients were cured with conservative treatment and 1 patient with severe infection left hospital without cure.Average length of hospital stay was (55.6 ± 30.5) days postoperatively.Anastomotic stenosis occurred in 11 patients (3.93％,11/280).In the experimental group,one patient (0.36％,1/280) with asymptomatic loculate leakage was hospitalized for 20 days,and finally cured and discharged.8 cases with anastomotic stenosis occurred in the experimental group (2.86％,8/280).There was statistic difference in the rate of intrathoracic anastomotic leakage between the two groups (P =0.044),but there was no statistic difference in anastomotic stenosis between the two groups (P =0.484).Conclusion The technique of great omentum combined with medical obturation glue for preventing thoracic cavity anastomotic leakage,which is easy to perform,can obviously decrease the occurrence and attenuate the symptom of intrathoracic anastomotic leakage,and anastomotic stenosis increases unobviously.It also can shorten the length of hospital stay and is worthy of clinical promotion.
RESUMO
Objective To evaluate the feasibility and efficacy of laparoscopic repair of vesicovaginal fistula (VVF) with omentum shift.Methods Sixteen VVF patients were reviewed retrospectively from July 2007 to July 2011,aged from 34 to 72 years with a mean age of 48 years.The history of leakage of urine ranged from 1 month to 30 years,of which 15 cases due to uterine operation complication and 1 case due to IUD perforation.All cases were single fistula,with the fistula diameter ＜ 1 cm in 13 cases and ＞ 1 cm in 3 cases.Fourteen cases of fistulas were in the vaginal wall,and 2 cases were in the cervix.Surgical techniques were transabdominal laparoscopic local displacement of the great omentum and conventional layered suture repair of vesicovaginal fistula.Results All surgeries were successful.The operation time was 120 -175 min,with an average of 150 min.The blood loss was 50 -300 ml,with an average of 120 ml.The postoperative hospital stay was 6 to 10 d,with an average of 8.5 d.The catheter indwelling time was 14 to 21 d,with an average of 17 d.During the period of follow-up for 3 to 45 months with an average of 23months,14 cases cured,1 case improved and 1 case failed.No major complications such as intestinal injury occurred.Conclusions Laparoscopic repair of VVF with great omentum shift has the characteristics of less damage,less pain and positive effect.The key points of the surgery are local filling of great omentum and delicate layered suture.