Peculiarities of surgical tactics in long cicatricial esophageal strictures


Keywords: cicatricial esophageal stricture; еsophagoplasty; gastrostomy; transhiatal access

Abstract

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.

References

1. Boyko VV, Yvanova YuV, Mushenko EV, Savvy SA. Method of preventing of failure of esophago-intestinal anastomoses. Shpitalna khirurgiia. 2013;3:139-40. [In Russian].



2. Boyko VV, Savvi SO, Zhydeckiiy VV, Bodrova AYu, Bikulova DU. Sposib ocinky efektyvnosti likuvannja hvoryh z gastroenterologichnymy zahvorjuvannjamy. Patent Ukrainy № 103176. 2015; Grud 23. [In Ukrainian].



3. Chernousov AF, Horobryh TV, Chernousov FA. Modern trends in the development of esophageal surgery. Herald of surgical gastroenterology. 2008;4:5-13. [In Russian].



4. Velygockiy NN. Intrathoracic stomach during plastic of the resected esophagus. Mezhdunarodniy Medycynskiy Zhurnal. 2001;1(7):61-5. [In Russian].



5. Veligockiy NN, Gorbulich AV, Teslenko IV, Trushin AS, Veligockij AN, Komarchuk VV. High esophagogastroplasty with damage of the intrathoracic parts of the esophagus. Kharkivska khirurgichna shkola. 2009;4.1(36): 41-4. [In Russian].



6. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg. 2000 Feb;119(2):277-88. PMID:10649203. DOI: 10.1016/S0022-5223(00)70183-8.



7. Parekh K, Iannettoni MD. Complications of esophageal resection and reconstruction. Semin Thorac Cardiovasc Surg. 2007;19(1):79-88. PMID: 17403462. doi: 10.1053/j.semtcvs.2006.11.002.



8. Luft VM, Luft AV. Clinical aspects of nutritional support in medicine: ideology, potentials, standards. Rosssan Open Medical Journal. 2009;(5):8-14. [In Russian].



9. Novik AA, Matveev SA, Popova TN. Assessment of life quality in medicine. Clinical Medicine. 2000;2:10-3. [In Russian].



10. Shvyreva NE, Mizikov VM, Stamov VI, Pejkarova AV. Nutritional status, anesthesia and early postoperative complications of patients after radical operations on the esophagus. Anaesthesiology and Reanimatology. 2011;3:69-73. [In Russian].



11. Farran-Teixido L, Miro-Martin M, Biondob S, Conde-Mouriñoc R, Bettonica-Larrañagaa C, Aranda Dansoa H, et al. Reconstrucción esofágica en un segundo tiempo: coloplastia y gastroplastia. Cir Esp. 2008;83(5):242-6.



12. Boyko VV, Savvi SO, Zhydeckssy VV, Bodrova AYu, Novikov YA. Sposib odnomomentnoi' ezofagogastroplastyky. Patent Ukrainy № 92357. 2014 Serp 15. [In Ukrainian].



13. Boyko VV, Savvi SO, Zhydeckssy VV, Bodrova AYu, Novikov YA. Sposib kontaktnoi gastrostomii. Patent Ukrainy № 92441. 2014 Serp 15. [In Ukrainian].



14. Boyko VV, Savvi SO, Zhydeckssy VV, Bodrova AYu, Novikov YA. Sposib plastyky stravohodu shlunkom. Patent Ukrainy № 96215. 2015 Sich 2. [In Ukrainian].

Author Biographies


V. V. Boyko, Zaytsev Institute of General and Urgent Surgery, Kharkiv

Boyko Valeriy Volodymyrovych - PhD, professor, T. Zaycev Institute of General and Urgent Surgery
Head Department of Surgery №1
Kharkiv National Medical University.
+380 57 715-3348
1, Balakireva vyizd, Kharkiv, Ukraine, 61103
igusurg@ukr.net 


S. О. Savvi, Kharkiv National Medical University

Savvi Sergii Oleksandrovych - PhD, Leading Researcher,
Head of the Department of pathology of esophagus and gastrointestinal tract
T Zaycev. Institute of General and Urgent Surgery
professor of the Department of Surgery №1
Kharkiv National Medical University.
The address: 1, Balakireva vyizd, Kharkiv, Ukraine, 61103
Tel. 380 50 3015060.
E-mail: savissa@ukr.net


А. Yu. Коrolebska, Kharkiv National Medical University

Korolevska Alla Jurii'vna - assistant of the department of Surgery №1
Kharkiv National Medical University
The address: 1, Balakireva vyizd, Kharkiv, Ukraine, 61103.
Tel. 380 67 3793118.
E-mail: korolevska@ukr.net


V. V. Zhydetskyi, Zaytsev Institute of General and Urgent Surgery, Kharkiv

Zhydetskii Vitalii Viktorovych – Researcher
Department of pathology of esophagus and gastrointestinal tract, T. Zaycev Institute of General and Urgent Surgery
The address: 1, Balakireva vyizd, Kharkiv, Ukraine, 61103.
Tel. 380 507252011.
E-mail: navidoc2014@ukr.net

Published
2018-01-28
How to Cite
Boyko, V. V., SavviS. О., КоrolebskaА. Y., & Zhydetskyi, V. V. (2018). Peculiarities of surgical tactics in long cicatricial esophageal strictures. Klinicheskaia Khirurgiia, (1), 52-55. https://doi.org/10.26779/2522-1396.2018.01.52
Section
General Problems of Surgery