ABSTRACT
Results of surgical treatment were analyzed in 128 patients operated for esophageal carcinoma and gastric cancer involving the esophagus. The role of anastomosis type was specified among risk factors for anastomosis insufficiency; efficacy of cuff anastomosis in prophylaxis of insufficiency was statistically proved.
Subject(s)
Esophagoplasty/methods , Esophagus/surgery , Stomach/surgery , Adult , Aged , Anastomosis, Surgical/adverse effects , Constriction, Pathologic/prevention & control , Esophagoplasty/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Reoperation , Retrospective Studies , Suture Techniques , Treatment FailureSubject(s)
Diaphragm/transplantation , Esophageal Neoplasms/surgery , Esophagoplasty/adverse effects , Gastroplasty/methods , Stomach Ulcer/surgery , Surgical Flaps , Esophagoplasty/methods , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , Stomach Ulcer/etiologyABSTRACT
The present paper presents 5 microscopic investigations of the morphology of a major bronchial stump area or tracheobronchial anastomosis after tightly fixing a vascularized diaphragmatic or omental flap. The cadaveric material of female patients who had died in different periods after diaphragmopexy or omentopexy was investigated. The authors' observations support the fact that diaphragmatic or omental flaps tightly sutured to the tracheobronchial wall can provide its revascularization and regeneration of the bronchial stump or tracheobronchial anastomosis.
Subject(s)
Bronchi/pathology , Diaphragm/surgery , Lung Neoplasms/surgery , Omentum/surgery , Surgical Flaps/pathology , Diaphragm/pathology , Humans , Male , Middle Aged , Omentum/pathology , PneumonectomyABSTRACT
Diaphragm flaps on the low diaphragm vessels cut by the method described were used in 39 patients for plasty of the stump of the main and lobe bronchus, tracheo-bronchial and inter-bronchial anastomosis, pericardium. In 38 (97.4%) out of 39 patients the diaphragm plasty proved to be effective, the mechanical and biological characteristics of the flap allowed the desired effect of plasty to be obtained. The method of cutting the low diaphragm flap used is simple, safe and allows the preparation of a good plasty material for different purposes in the thoracic surgery.
Subject(s)
Diaphragm , Surgical Flaps , Thoracic Surgical Procedures , Follow-Up Studies , Humans , Time FactorsABSTRACT
Use of vascular flap to cover the principal bronchus stump for prevention of bronchopleural fistula is generally known. To provide objective evidence on relevant indications, a multivariate analysis of 14 potential risk factors of suture failure was undertaken. Right-side surgery and preoperative irradiation appeared to be significant (p<0,05) factors of high risk (over 25%) for stump suture failure. Either risk factor may be regarded as indication for making preventive plastic cover.
Subject(s)
Lung Neoplasms/pathology , Female , Humans , Lung Neoplasms/surgery , Male , Middle Aged , Multivariate Analysis , Prognosis , Risk FactorsABSTRACT
Anastomotic leakage due to loosening of sutures is the frequent cause of lethality. To prevent such complication, a sleeve-type esophago-enteric and esophagogastric anastomosis was used. Its design eliminates the major cause of failure--the basic sutures running through the soft muscular wall of the esophagus. The new anastomosis was used in ca. 42 patients: Lewis operation (24), proximal resection of the stomach and distal thoracic part of the esophagus and adjuvant intrapleural esophagoplasty with the distal end of the stomach (8), gastrectomy with resection of the distal thoracic part of the esophagus and concomitant intrapleural esophagoplasty with small intestine (S.S.Yudin) (10). Postoperative complications were reported in 18 patients (42.9%); lethality--11.9%. No leaking esophageal anastomosis was registered.
Subject(s)
Esophageal Neoplasms/surgery , Esophagoplasty/methods , Intestine, Small/surgery , Stomach/surgery , Suture Techniques , Adult , Aged , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Esophagoplasty/adverse effects , Esophagoplasty/mortality , Female , Humans , Male , Middle Aged , Thoracic Cavity , Treatment OutcomeABSTRACT
An analysis of risk factors of incompetence of the bronchus stump or tracheobronchial anastomosis has shown that the statistically reliable factors (p < 0.05) were: male gender of the patient, neglected lung cancer, high degree of purulent intoxication, preoperative gamma-therapy, certain kinds of performing sutures, the degree of acute respiratory insufficiency. The traditional methods of plasty of the primary bronchus stump or tracheobronchial anastomosis in patients with the high objective risk of the development of incompetence of their sutures are known to be not effective. An experience with 70 prophylactic and curative omentoplasties has shown than the application of the greater omentum for plasty can substantially reduce frequency of the formation of acute bronchopleural fistulas, but the technique of fixation of the omentum to the trachea and opposite primary bronchus is of great significance for realization of the omentum plasty potential.
