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TREATMENT TACTICS OF PATIENTS WITH CONCOMITANT POST-BURN CICATRICIAL ESOPHAGEAL AND GASTRIC STRICTURES

 

Z.M. NIZAMHOJAYEV, R.E. LIGAY, D.S. ABDULLAYEV, J.A. HAJIBAYEV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,



UZBEKISTAN

 

Purpose: To examine the results of single-stage surgical interventions in patients with concomitant postburn cicatricial esophageal and gastric strictures (PSEFS).

Material and methods: 145 patients with combined PSEFS were treated in the Department of esophageal and gastric surgery. Localization of the combined gastric lesions was as follows: pylorus - in 15 (10.3%), antral part - in 114 (78.6%), antral part + lower third of the body of stomach - in 7 (4.8%), body of stomach - in 3 (2.1%), subtotal lesion - in 2 (1.4%) and total in 4 (2.7%) patients.

Results and discussion: Tactics of surgical treatment was determined subject to the degree of prevalence of patency disorders in the esophagus or stomach.

I group consisted of 12 patients with prevailing disorders of the gastric evacuation: II grade stenosis - in 3 (25%) and III grade in 9 (75%). In connection with there were performed gastric operations: GDA by Jabuley - 2, GEA with EEA 4, resection of the ½ of a stomach - 2, resection of 2/3 of a stomach - 3 and gastrectomy in 1 patient.

II group consisted of 54 patients with combined PSEFS, with prevailing disorders of esophageal patency: 51 patients were performed bougienage, and 3 - shunting coloplasty.

III group consisted of 79 patients with combined PSEFS with equally expressed signs of disorders in esophageal patency and gastric evacuation, in connection with which there were indications for their single-stage correction. The nature of interventions in the esophagus was as follows: bougienage - in 51, gastrostomy - in 11, resection of n/3 of the esophagus - in 1, extirpation of the esophagus - in 1, and shunting coloplasty in 15 patients. Nature of the recovery of gastric evacuation disorders was as follows: GEA with EEA in 19, GDA by Jabuley in 6, pyloroplasty in 9, local gastric plastic in 4, resection of ½ of stomach in 20, resection of 2/3 of stomach in 2, subtotal gastric resection in 1, gastrectomy in 2, bypass colojejunoanastomosis in 1 patient. In the postoperative period, fatal outcome in 4 patients, which constituted 2.7%.

Conclusion: Patients with combined PSEFS in the structure of benign esophageal diseases pose a great difficulty. Selection of an optimal surgical treatment tactic, which must be strictly individual and depend on several factors: age and condition of the patient, time from the moment of burn of the digestive tract, extent and localization of the esophageal and gastric stricture, as well as the nature of earlier surgical interventions remain important issue.

 

EFFICIENCY OF THE ESOPHAGEAL EXTIRPATION IN SURGICAL TREATMENT OF ESOPHAGEAL ACHALASIA

 

Z.M. NIZAMHOJAYEV, R.E. LIGAY, KH.N. BEKCHANOV, A.O. TSOY, A.G. MIRZAKULOV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,



UZBEKISTAN

 

Purpose: To study results of surgical treatment of patients with advanced stages of esophageal achalasia.

Material and methods: 21 patients with advanced stages (III-IV) of esophageal achalasia were performed surgical treatment from 1997 to 2011 at the Department of esophageal and gastric surgery. Among them there were 8 men and 13 women, aged between 11 - 64 years.

Results and discussion: The indications for surgical treatment included ineffectiveness or impossibility of cardiodilatation. During surgical correction there was used a developed differentiated approach to the selection of operations based on the difference in clinical course of two types of the disease (cardiospasm - hyperkinetic and achalasia - hypokinetic).

In the achalasia, the reflex of cardiac opening in response to swallowing was completely absent, with GEGP corresponding to normal controls, and sometimes is even below normal. However, achalasia is characterized by a sharply weakened peristalsis of the esophagus, which prevents adequate cardiac patency, even against the background of low GEGP. Consequently, the performance of different variants surgical correction of the cardia in the II type can not provide normal passage food, and therefore, it is necessary to perform extirpation of the esophagus, used in 21 patients.

In 20 cases there was used abdomino-cervical access, which is preferable in the category of patients. In 1 patient with concomitant echinococcosis of the right lung there was performed simultaneous operation, in connection with which, there was used thoraco-abdomino-cervical access.

In the selection of a method of esophagoplasty we prefer using of isoperistaltic gastric tube from a greater curvature of stomach, which was used in 17 patients. Only in 4 patients for the creation of a transplant there was used the left half of the colon because of the impossibility of gastroplasty.

In the postoperative period, esophagogastroanastomotic failure occurred only in 1 (5%) patient, which was removed conservatively. There were no fatal outcomes, all the patients were discharged in satisfactory condition.

Conclusion: Esophageal extirpation is a pathogenetically substantiated intervention in patients with advanced stages of esophageal achalasia and should be an operation of choice in this category of patients.

 


Date: 2014-12-28; view: 270


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