Peculiarities of surgical treatment of esophageal diverticula of large dimensions


Keywords: esophageal diverticula; fenestration of residual cavity; еlectric welding of tissues; a wedge-like esophageal suture

Abstract

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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Author Biographies


V. V. Yatskyv, Bukovyna State Medical University, Chernivtsi, Chernivtsi Regional Clinical Hospital

Yatskyv Vasyl Vasylovych - MD, PhD, associate professor

department of surgery # 1

Bukovinian State Medical University,

head of the department of thoracic surgery

Chernivtsi Regional Clinical Hospital.

58018, Chernivtsi, Golovna st. 137,

Regional Clinical Hospital;

032 56 72 33

v.v.yazkiv@gmail.com;

ORCID ID: 0000-0002-4609-1417.


I. Yu. Polyansky, Bukovyna State Medical University, Chernivtsi

Polyansky Igor Yuliyovych - Doctor of Medical Science, Professor,

Head of the Surgery Departmen # 1

Bukovinian State Medical University,

58018, Chernivtsi, Golovna st. 137,

Tel. Mob 050 5192472;

ipolyanskiy@ukr.net;

ORCID ID: 0000-0001-6520-1143.


S. E. Frimet, Chernivtsi Regional Clinical Hospital

Frimet Sergiy Eduardovich- doctor resident

Department of Thoracic Surgery,

Regional Clinical Hospital;

58018, Chernivtsi, Golovna st. 137,

Tel. Mob 0505194634;

ORCID ID: 0000-0001-5351-2921.


V. P. Slyvka, Chernivtsi Regional Clinical Hospital

Slyvka Vasyl Petrovich - doctor resident

Department of Thoracic Surgery,

Regional Clinical Hospital

58018, Chernivtsi, Golovna st. 137,

Tel. Mob 0505987412;

ORCID ID: https://orcid.org/0000-0003-0428-8411.


Yu. D. Lukyanchuk, Chernivtsi Regional Clinical Hospital

Lukyanchuk Yuriy Dmytrovych - doctor resident

Department of Thoracic Surgery,

Regional Clinical Hospital

58018, Chernivtsi, Golovna st. 137,

Tel. Mob0506662616 ;

ORCID ID: 0000-0003-0073-3039.


S. M. Mereuca, Chernivtsi Regional Clinical Hospital

Mereuca Stella Mikhailovna -

doctor-pulmonologist

Regional Consultative Polyclinic. 5

8018, Chernivtsi, Golovna st. 137,

Tel. Mob 0506907920;

ORCID ID: 0000-0001-9162-6196.

Published
2019-01-30
How to Cite
Yatskyv, V. V., Polyansky, I. Y., Frimet, S. E., Slyvka, V. P., Lukyanchuk, Y. D., & Mereuca, S. M. (2019). Peculiarities of surgical treatment of esophageal diverticula of large dimensions. Klinicheskaia Khirurgiia, 86(1), 13-16. https://doi.org/10.26779/2522-1396.2019.01.13
Section
General Problems of Surgery