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REGURGITATIONAL COMPLICATIONS AFTER DISTAL RESECTION OF ESOPHAGUS

 

N.V. GIBADULIN, I.O. GIBADULINA

Central Research Institute of Gastroenterology, Moscow, RUSSIA

 

Introduction: Distal resection of esophagus with primary esohagogastroplasty often provokes pathological states caused by gastro-esophageal-pharyngeal reflux. Regurgitation of the content of a gastric stump leads to inflammatory-atrophic changes in the mucous membrane of the stump of esophagus and pharynx, causes the development of aspiration bronchitis and pneumonia. The formation of functionally active esophagogastroanasthomosis is one of the ways of solving the problem of prevention of reflux complications during plastic replacement of the affected esophagus.

Materials and methods: 11 patients with benign stenotic lesions of a distal area of esophagus (8 males and 3 females in the average age of 51,2 ± 3,7 years) were included in the present study. The indications for surgery were a peptic stricture of a distal area of esophagus in 9 (81.8%) patients, Barrett's esophagus - in 2 patients. 6 (54.5%) patients previously underwent repeated bougienage and endoscopic dilatation of the zone of esophageal stricture. In one patient a spread dysplasia of a stratified squamous epithelium of varying degree with areas of carcinoma in situ was a chance find in the preparation of the resected esophagus.

Results and discussion: The operation consisted of a transhiatal mobilization and resection of esophagus within the healthy tissue at the level of its suprastenotic dilation after the wide sagittal diaphragmcrurotomy. Then, from the greater curvature of stomach is formed a 2.5-3 cm wide tubular graft, which is carried into the posterior mediastinum and anasthomose with the stump of esophagus. We used the method of formation of a cervical antireflux esophagogastroanasthomosis, developed under the guidance of prof. G.K. Zjerlov for subtotal resection of esophagus with simultaneous esophagogastroplasty (patent ¹2143849 from 10.01.2000). The proposed method consists of formation of the esophageal muscle sphincter at the distal end of the stump, consisting of duplikatury of a muscle membrane and the creation of invaginated valve from muco-submucosal layers of esophageal stump and gastric transplant. Lethal outcomes and complications of early postoperative period associated with the failure of esophageal-gastric anasthomosis were not observed. In 7 (63.6%) patients was noted a transient dysphagia within 7-10 days. Complications of a general surgical nature arose in one patient (9%) and were associated with the development of bilateral pneumonia, which served as a pretext to delay discharge from the hospital. The postoperative hospital stay was 12,7 ± 2,3. Excellent and good functional outcomes were noted in 8 (72.7%) patients, satisfactory results were connected with the development of postvagotomic mild diarrhea in 2 cases and of transient dysphagia against the background of psychological and emotional lability in one case. The results of radiographic and endoscopic studies have confirmed the reliability of the antireflux function of the formed esoahgogastroanasthomosis.



Conclusion: Transhiatal resection of lower thoracic part of esophagus, primary esophagogastroplasty with formation of antireflux anasthomosis ensures reliable prevention of postoperative regurgitational complications that can improve the quality of life in patients with stenotic lesions of the distal esophagus.

 

 

EXTRA-ESOPHAGEAL MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD): PATHOGENESIS, CLINICS, TREATMENT

 

N.B. GUBERGRITS, G.M. LUKASHEWICH

 

National Medical University n.a. M. Gorky, Donetsk, UKRAINE

Extra-esophageal manifestations of GERD occur in 65% of children with asthma disease. In older patients extra-esophageal manifestations of GERD develop in 60% of cases with prevalence of cardiac symptoms. Clinically extra-esophageal manifestations of GERD are divided into oropharyngeal, otolaryngologic, bronchopulmonary, cardiac and rare (hiccups, anemia, etc.). The pathogenesis consists of two main mechanisms: reflex action and direct contact with gastric contents. In the diagnosis of extra-esophageal manifestations of GERD pH-monitoring, endoscopy, PPI-test and other are used. Proton pump inhibitors (PPIs) are the most important in the treatment. Among this group of drugs pantoprazole has a lot of advantages. It stops the daytime and nighttime manifestations of GERD faster than any other PPI and has high bioavailability. The value of bioavailability is constant after the first dose. Food intake and antacids do not affect on the bioavailability. Pantoprazole binds with two cystines of ​​proton pump, so it works longer than other PPIs. Pantoprazole reduces the frequency of GERD recurrences by 10%. It acts selectively on the gastric proton pumps, so the possibility of adverse effects is minimal. The effect on the metabolism of other drugs is not significant too. Pantoprazole has the optimal quality-price ratio. If necessary, an endoscopic or surgical treatment is prescribed.

 


Date: 2014-12-28; view: 881


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