Peculiarities of surgical treatment of esophageal diverticula of large dimensions
Objective. To improve the results of surgical treatment of esophageal diverticulas (ED), using the improved procedures of operative interventions for prevention of the morbidity occurrence.
Маterials and methods. Experience of treatment of 58 patients, having ED of various localization, is adduced. In 13.8% patients the ED were over 5 сm in size. Dysphagia as a principal clinical sign and was observed in 32 (55.2%) patients, the disease course was free of symptoms in 3(5.2%), and a complicated one - in 39 (67.2%). In all the patients with ED, owing large size, a diverticulitis was diagnosed. Prominent perifocal fibrosis, formation of residual cavities in ED were revealed in 5 (8.6%) patients. The fibrosis severity was correlated with the disease duration from 4 to 10 yrs.
Results. The open operative access was performed in 58 patients, and simultant operations for achalasia - in 3. Endoscopic support was applied suboperatively. Fenestration of fibrotic residual cavities was applied, using the electric welding technologies. Postoperative complications have occurred in 2 (3.4%) patients. There was no lethality. ED of large size have wide mouth of incorrect form, that’s why in 4 patients a wedge-like mechanical suture in a transverse direction was applied. Follow-up investigations were conducted in terms up to 1 yr, the esophageal lumen was completely preserved and was free of defects.
Conclusion. Surgical treatment of ED is a well established way of their management. Modern methods of diagnosis must be applied preoperatively and suboperatively. For ED of large size, owing wide mouth, fibrotic residual cavities it is expedient to use a wedge-like suture at the base of ED with the help of endostaplers, and fenestration, using electric welding technologies for reduction of the morbidity occurrence risk.
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