[Overview of reconstructive surgery and functional compensation in the digestive tract]. / Osvrt na rekonstrukciju i kompenzaciju funkcije digestivnog trakta.

This paper represents a short and overall overview of the reconstructive procedures of the esophagus, stomach, colon and rectum. Optimal reconstructive procedure has not been chosen only for the reconstruction of the digestive system. Precise selection of the patients and reconstructive methods must enable the correction of the possible functional disadvantages. Usage of adaptional and reserve possibilities of other organs and tissues will help the functional compensation of the lost segments of the digestive system. The understanding of the importance of the physiological approach to the reconstruction of the digestive system using the segments of stomach, jejunum or colon is of the most importance so that in this difficult segment of surgery adequate improvements can be achieved.

Modification of the Merendino procedure.

The jejunal interposition operation after resection of distal esophagus and cardia, designed by Merendino and Dilard, has not been widely employed until now. The complexity of the procedure, demanding high performance, and still unacceptable postoperative mortality, were limiting factors and a challenge for many surgeons. The aim of this paper is to present three modifications of the original technique, without changing the basic concept of the Merendino procedure. These modifications differ from the original technique in three main ways: the longer isoperistaltic jejunal segment, the terminolateral mechanical esophagojejuno anastomosis, and the placement of the lower jejunogastric anastomosis on the posterior wall of the stomach. This report comprises an experience in 29 patients operated on in period 1972 through 1995. There were two postoperative deaths and long-term results were excellent in all except one patient who had an ischemic stenosis of the transplanted jejunal segment. Despite this, the Merendino procedure, simplified by these modifications, deserves to be more frequently used in the treatment of undilatable or recurrent strictures and other benign lesions which require resection of the distal esophagus and cardia.

Esophagocoloplasty in the management of postcorrosive strictures of the esophagus.

The clinical data, technical considerations, early and late post-operative complications, and long-term follow-up results of esophagocoloplasty in the management of 176 patients with postcorrosive stricture of the esophagus are presented. All 176 colon segments were placed in the isoperistaltic position. Left colon transplants were used in 66.47% and the right colon with terminal ileum was used in 33.52% of patients. The postoperative mortality rate in the entire series was 5.68%. In the past 10 years the postoperative mortality rate was reduced to 1.96%. Long-term follow-up examinations were done for 144 patients (81.81%). Excellent results were noted in 87.50%, satisfactory results in 10.41%, and poor results in 2.08% of surgically treated patients at regular yearly check-ups during a follow-up period ranging from 1 to 24 years after operation.