Peculiarities of surgical tactics in long cicatricial esophageal strictures
Objective – improvement of the treatment results in patients, suffering long post-burn cicatricial esophageal strictures (PBCES), using the existing surgical tactics.
Маterials and methods. Results of treatment of 156 patients, suffering PBCES, in 2000 - 2017 yrs were presented. Surgical treatment in accordance to the Clinic method was conducted in the main group patients, and classic procedures of operative treatment were applied in the comparison group. The patients of claster І were subjected to one-staged esophagoplasty, and the rest – to two-staged surgical treatment with the contact gastrostomy performance (claster ІІ) and esophagoplasty (claster ІІІ).
Results. Of the patients, suffering PBCES, of the comparison group claster І postoperatively in 12 (46.2%) complications have occurred: pleuritis - in 3 (11.5%), pneumonia - in 2 (7.7%); 3 (11.5%) patients died. Postoperative morbidity have occurred in 1 (4.2%) patient of the main group claster І: partial insufficiency of esophagogastoanastomosis on the neck. Lethality constitutes 4.2% (1 patient died as a consequence of an acute cardio-vascular insufficiency). In 4 (15.38%) patients claster ІІ of the comparison group the pendant suture eruption was noted, among the main group patients the complications were absent. In the comparison group of claster ІІІ complications were noted in 5 (18.5%) patients: in 3 (11.1%) – partial insufficiency of esophagocolonoanastomosis on the neck, in 2 (7.5%) – necrosis of proximal part of the large-bowel transplant, transposed into esophageal position, with total insufficiency of esophagocolonoanastomosis; and 2 (7.5%) patients after esophagocolonoplasty, using combined thoracoabdominal access (an acute cardio-vascular insufficiency and polyorgan insufficiency), died. Postoperative complications in the main group of claster ІІІ were not observed.
Conclusion. Tactics of surgical treatment was elaborated and introduced, basing on accounting of trophologic state and compensation possibilities of organism of the patient with PBCES, promotes improvement of the treatment results and the life quality of the operated patients.
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