[Incomplete esophagoplasty].
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Biomedical subjects
Publications and source records attributed to A F Chernousov.
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The main causes of unsatisfactory results after Nissen fundoplication can usually be explained by tactical and technical mistakes. The fixation of the stomach to the diaphragm is one case of the development of pain syndrome, telescopic phenomenon and relative or complete dispersion of fundoplication with subsequent development of a recurrent reflux oesophagitis. The fundoplication should be done only in hospitals which have experience in oesophageal and gastric surgery. The collar of fundoplication should be formed with the two sides (the anterior and the posterior) of the stomach after extensive mobilisation of the cardia region. The operation includes the obligatory fixation of the collar to the oesophagus in order to avoid complications like pain syndrome, sliding of the collar and recurrent reflux oesophagitis.
In the treatment of corrosive strictures of the esophagus the subsequent development of carcinoma in the cicatrixed esophagus should be taken into consideration. Prophylactic measures should be undertaken. In case of severe persistent stenosis surgery is the most adequate management.
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In 39 patients cardiospasm was associated with a hiatal hernia or the latter was formed in the process of treatment by cardiodilatation. An analysis of results of the treatment has shown that pneumocardiodilatation under control of esophagomanometry should be considered the method of choice in the treatment of such patients. The decreased gradient of the gastroesophageal pressure up to 12-14 mm of mercury is responsible for prevention of reflux-esophagitis. Operative treatment is indicated when cardiodilatation is ineffective or the manometric control is impossible. Cardiomyotomy in combination with an "incomplete" fundoplication is preferable. There are no good reasons for performing fundoplication after Nissen in patients with cardiospasm.
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