IMPROVED METHOD OF SURGICAL TREATMENT OF STRICTURES OF ESOPHAGEAL ANASTOMOSES

Z.M. NIZAMKHOJAYEV, R.E. LIGAY, A.O. TSOY, J.A. HAJIBAYEV, D.S.ABDULLAYEV

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

UZBEKISTAN

Purpose: To improve the technique of reconstructive surgery in patients with cicatricial strictures of esophageal anastomosis (CSEA).

Material and methods: 58 patients with CSEA were treated at the department of esophageal and gastric surgery of RSCS named academician V.Vahidov in the period between 1991 and 2010. The diagnosis of CSEA was set on the basis of endoscopic and radiological studies. Subject to the degree and extent of CSEA, the patients were conducted following methods of treatment: endoscopic bougienage (EB) with replaceable metal olives - in 3; endoscopic diathermoforage (EDF) in 5; EDF + EB - in 3, string bougienage - in 25; hydroballoon dilation in 3 and reconstructive operations - in 19 patients.

Results and discussions: Reconstruction of anastomosis by ¾ type of the operation was performed in 12 patients, resection of anastomosis with the insertion of a new anastomosis was performed in 2 patients, the removal of an enteral transplant with single-time shunting coloesophagoplasty with a creation of a new esophagocoloanastomosis was performed in 1 patient.

In the classic operation of ¾ type there was performed correction on only the front wall of the narrowed of anastomosis, which is sufficient to increase of the lumen of anastomosis, however, with remaining deformation of the posterior wall, which in long-term period may lead to recurrence of strictures. To improve long-term results, we improved methods of reconstructive surgery. The idea of the proposed method is to correct both the anterior and posterior walls of the anastomosis with the use of precision equipment. The essence of operation consists of a longitudinal dissection of the anterior wall of the anastomosis with the excision of cicatrical tissue and then the posterior wall of the narrowed anastomosis is dissected longitudinally without opening of the lumen with a cross-suturing of muco-submucosal layer, the operation is completed by cross-suturing of the anterior wall of the esophageal anastomosis. The operation was performed in 4 patients. In the postoperative period, the patients had no complications. In the distant period within 3 years all four patients were examined, with no signs of recurrent anastomosic stritures according to clinical data and data of comprehensive examination.

Conclusion: CSEA are the most common causes of unsatisfactory results of esophagoplasty. Tactics of treatment in patients with CSEA should be individual, with instrumental techniques begin priority in these patients. Repeated reconstructive operations in CSEA are one of the most difficult interventions in reconstructive surgery of the esophagus, which should be used only in case of inefficiency or impossibility of mini-invasive methods.

Date: 2014-12-28; view: 991