[The variations of transplant anastomosis to the pharynx or esophagus during partial or total esophagoplasty].

Different modifications of colic and gastric transplants connection to the gullet or esophagus in the neck have been described. The most functional and cosmetic types of anastomoses have been specified. The utility of single-stage subtotal or total esophagoplasty with the use of colon segment regardless of the transplant length has been proved. The short- and long-term follow up of different modifications of anastomoses has been given.

[Application of total and subtotal esophagoplasty in the treatment of cicatricial esophageal stenosis].

The most safe variants of subtotal (in 58 patients) and total (in 20) esophagoplasty performance, using colonic segment (y 76) and stomach (in 2) for cicatricial esophageal stenosis with cervical anastomosis formation with pharynx (in 20) and esophagus (in 58) were used. Main stages of the patients preoperative preparation were determined, securing achievement of best immediate and late results after artificial esophagus formation. The expediency of a one-staged subtotal and total esophagoplasty performance was proved, using colonic segment, independent of the transplant length. The immediate and late results were analyzed.

Reconstructive surgery for combined tracheo-esophageal injuries and their sequelae.

OBJECTIVE: To evaluate surgical options of treatment in combined tracheo-esophageal injuries and their sequelae and elaborate new ones. METHODS: The overlooked diagnosis of combined tracheo-esophageal injury would lead to severe stenosis of the esophagus and trachea with tracheo-esophageal fistula. This condition requires a complex surgical intervention to be performed with non-standard procedure in every single case. Forty patients with combined tracheo-esophageal injuries were treated in our institution. Nine patients were urgently operated while others were transferred to us from other hospitals with chronic sequelae of the initial trauma. RESULTS: In the majority of cases the cause of the injury was penetrating (17 patients) or iatrogenic (13 patients) trauma followed by blunt neck and chest trauma (six patients) and caustic burn (four patients). Three patients had total cut off of the esophagus and trachea, which were repaired with end-to-end anastomoses. Another six patients had tracheal and esophageal disruptions within one-half to three-quarters of circumference. In these cases both the trachea and esophagus were mobilized within wall laceration and sutured by interrupted Vicryl 4/0. One of them died due to pre-existing disease. Thirty-one patients with sequelae of the trauma were also operated on. In spite of the complexity and extent of the tracheo-esophageal stenosis and fistula the surgical treatment was aimed to one-stage reconstruction of both the esophagus and trachea. For this purpose we performed an originally developed surgical intervention, which was to be modified in accordance with patients diagnosis. The main point of the procedure is that after mobilization of the trachea and esophagus we resect an involved part of the trachea, but preserve a pedicled flap fashioned from the tracheal membrane. Then we remove the mucosa from the flap, resect an involved esophageal wall, repair esophageal mucosa and replace the defect of the muscular layer of the esophagus with the tracheal flap. Then a tracheal or laryngo-tracheal anastomosis is established. There were no postoperative mortality and complications among patients with the sequelae. CONCLUSION: Combined tracheo-esophageal injury requires the precise preoperative diagnosis and well organized plan of surgical treatment, which may be unique for every single patient. The main purpose of the treatment is to restore the continuity of both the esophagus and trachea in one-stage intervention.

[Prevention and treatment of complications after reconstructive surgery on the trachea]. / Profilaktika i lechenie oslozhnenii posle vypolneniia rekonstruktivnykh operatsii na trakhee.

The results of treatment of 590 patients are analyzed, to whom the operations on trachea were conducted. In 91 patient 99 complications have occurred, 35 (6.4%) patients died. But due to the operation method refinement, new approaches elaboration, improvement of the measures of tracheoplasty complications prophylaxis and treatment, 2 (1.4%) patients died of 142 operated on during last years.