[Esophagectomy without thoracotomy using a stripping method: technic, results, indications in benign and malignant diseases of the esophagus]. / L'oesophagectomie sans thoracotomie par retournement: technique, résultats, indications dans les affections bénignes et malignes de l'oesophage.

A technique of esophagectomy without thoracotomy using a stripper with limited dissection of the mediastinum has been applied to 48 patients: neoplasia in 41 (squamous-cell carcinoma of the esophagus: 34, carcinoma of the gastric cardia: 5, pharyngeal carcinoma: 2) and non-malignant pathology in 7 (2 caustic necroses, 2 ruptured esophagus, 2 anastomotic leakages after gastro-esophageal resection, 1 caustic stenosis). There were 3 post-operative deaths. The best indications of this procedure are extended tumors of the lower esophagus in poor-risk patients, and perhaps superficial carcinomas of the esophagus whatever the site. The usefulness of this technique in such situations as perforations and mediastinitis is emphasized.

[Functional studies of the esophagus in gastroesophageal reflux: application to anti-reflux surgery]. / Les explorations fonctionnelles de l'oesophage dans le reflux gastro-oesophagien: application á la chirurgie anti-reflux.

A functional exploration of the esophagus, an acid reflux test, a manometry and an endoscopic examination were performed on 56 patients in succession, who had undergone a complete fundoplication for gastro-esophageal reflux. These tests were done pre-operatively as well as post-operatively at short term (1 year) and long term (4 years). The functional and endoscopic pre-operative work-up did not enable to isolate a group of patients likely to present a therapeutic failure. 54 patients were seen again at 1 year, with a good clinical result in 50 of them (92 per cent). At 4 years, 39 out of 48 patients (81 per cent) maintained that result. The acid reflux test was abnormal in all cases of clinical recurrence. Two asymptomatic patients had an abnormal test. One presented a clinical recurrence subsequently, the other had a severe esophagitis confirming the recurrence. On manometry, a significant and stable increase of the pressure of the lower esophageal sphincter was noticed after fundoplication (8.1 +/- 1.8 mmHg pre-operatively, 15.5 +/- 1.4 mmHg at 1 year, 14.5 +/- 1.5 mmHg at 4 years). In case of recurrence, the pressures were in an average lower although values within normal limits could not exclude a recurrence. A complete fundoplication is therefore a reliable long term procedure. The functional exploration of the esophagus post-operatively enables to select asymptomatic patients with a high recurrence risk and gives an objective evaluation of the operative results.

[Completed calibrated fundoplication]. / La fundoplicature complète calibrée.

Complete fundoplication at present is the most effective surgical treatment of gastro-oesophageal reflux. However, it has a number of side-effects, including post-operative dysphagia, inability to eructate and painful gastric distension. Fifty-five patients were operated upon using a technique which comprises wide gastric release and fabrication of a tension-free valve around a 50F probe introduced through the mouth. After 1 year, 94% of patients were free of reflux and 22% had mild dysphagia. After 3 years, the proportion of reflux-free patients still was 94%; 12% suffered from mild dysphagia and 6% had problems with eructation. Thus, calibration of the oesophagus with a 50F probe reduces the side-effects of complete fundoplication while remaining effective against gastro-oesophageal reflux.