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At least 37 records · Page 2Linked to original sources

PubMed2003

Fundal tube esophagoplasty for esophageal reconstruction in atresia.

PURPOSE: This is a report of 4 patients with long gap/pure esophageal atresia, who, after an initial gastrostomy and cervical esophagostomy at birth, were treated with a new technique called fundal tube esophagoplasty. METHODS: The technique consisted of mobilization of the distal esophageal stump, division of the left gastric artery, and mobilization of upper half of stomach. Both walls of the stomach were incised in the region of the fundus starting on the lesser curvature in such a way that a tube was created out of the fundus, and the native esophageal stump appears to be an extension of this neoesophagus. This neoesophagus was brought to the neck by the retrosternal route and in a second stage, esophago-esophageal anastomosis was made. Thal's fundoplication was added in 2 cases. RESULTS: All the stages have been completed successfully in 4 babies. They have been followed up for periods ranging from 8 to 24 months after restoration of esophageal continuity. All the children are thriving. CONCLUSIONS: Fundal tube esophagoplasty (1) serves to provide a neoesophagus of natural caliber, (2) utilizes native esophagus in reconstruction, (3) does not produce a space-occupying problem in the mediastinum, and (4) preserves the gastric reservoir function. In this early experience, it appears to fulfill all the requirements of a good esophageal substitute.

Child, Preschool↗

PubMed2001

Patch esophagoplasty using AlloDerm as a tissue scaffold.

BACKGROUND/PURPOSE: Anastomotic leak and stricture are common causes of morbidity after esophageal repair. The authors describe a technique of patch esophagoplasty using decellularized human skin. METHODS: Twelve conditioned dogs underwent a cervical 2.0- x 1.0-cm esophagoplasty with AlloDerm. A gastrostomy tube was used for feedings until an esophagram was performed on the 10th to 14th postoperative day. Dogs were then given oral chow and followed up for leak and dysphagia. Animals were killed at 1-, 2-, and 3-month intervals and evaluated for stricture, diverticula formation, and patch histology. RESULTS: All animals survived, and none had sepsis or dysphagia. All esophagrams were without evidence of leak or stricture. At death there were no strictures or diverticula. Histologic examination of 1-month specimens showed partial reepithelialization of the patch with neovascularization. Control staining of AlloDerm was strongly positive for elastin. This was decreased in the region of the patch at 1 month. Two-month specimens showed intact epithelium and an increase in the caliber of new blood vessels. Three-month specimens showed no significant variation from 2-month animals. CONCLUSION: Decellularized human skin (AlloDerm) provides a temporary collagen framework on which esophageal healing can occur and function can be maintained.

Animals↗

PubMed1976

[Clinical characteristics of intestinal esophagoplasty in cicatricial stenosis of the esophagus].

In 136 patients with cicatrical strictures of the esophagus the author performed total esophagoplasty, using the left colon (89 cases), the right colon with terminal iliac portion (8 cases), the small intestine by Roux-Herzen-Judin technic (27 cases) and the small intestine with primary reconstruction of the graft (12 cases). The results obtained and also early and late complications of the methods of esophagoplasty employed are clinically analysed. Based on clinical examinations of the patients within the terms from 1 to 16 years, the data of roentgenokinematography and the degree of their rehabilitation, the function of a newly constructed esophagus is estimated.

Adolescent↗

PubMed2000

[Gastrostomy as a stage of esophagoplasty].

The description of a modified technique of gastrostoma formation on small flexure is presented. Indications for this operation in patients with tumor and cicatrical esophageal strictures, planned for gastric esophagoplasty are formulated. The are authors regard a correctly created gastrostoma as the first stage of esophagoplasty. The main mistakes in gastrostoma creation that donTt permit to use the stomach for esophagus replacement are noted. The main principles and techniques of stoma creation on small flexure are described. The presented method is recommended for use in specialized esophageal departments and in general surgical hospitals.

Esophageal Stenosis↗

PubMed2002

[Local esophagoplasty in patients with burn strictures of the esophagus].

Local plastic reconstruction of short burn strictures of the esophagus (SBSE) was performed in 14 patients aged from 22 to 37 years, 9 were men, 5--women. Decreased body mass was revealed in all the patients, mass deficit over 20% was in 4 (28.6%) of them. SBSE located in the upper third of the esophagus in 9 (64.3%) patients, in middle third--in 5 (35.7%). Local esophagoplasty was performed from cervical approach in 9 (64.3%) patients, from right-sided thoracotomy--in 5 (35.7%). Dissection of SBSE with 3/4 anastomosis was performed in 5 (35.7%) patients; circulatory resection of esophageal stricture with end-to-end anastomosis--in 7 (50.0%); detour side-to-side anastomosis without stricture resection--in 2 (14.3%). There was no hospital lethality. Postoperative complications were seen in 14.2% cases. Long-term results were good in 10 (71.4%) patients, satisfactory (strictures of anastomosis)--in 3 (21.4%), unsatisfactory--in 1 (7.2%). Local esophagoplasty is indicated for patients with SBSE when bouginage and dilatation of stenosis are not effective.

Adult↗

PubMed2003

[Esophagoplasty with the colon in flap patients with burn strictures of the esophagus].

Results of coloesophagoplasty in 366 patients with long burn strictures of the esophagus are presented. The lesion was total in 74 (21.2%) of them. Inefficacy of bougieurage was indication for plastic surgery in 133 (36.3%) patients, complete obliteration of esophagus--in 53 (14.5%). Left half of the colon was used in 296 (80.9%) cases, transverse colon--in 48 (13.1%), right half of the colon--in 22 (6.0%) cases. Retrosternal shunting esophagoplasty was performed in 247 (67.5%) patients. Complications were in 84 (34.0%), necrosis of the transplant--in 4 (1.6%) patients. Extirpation of the esophagus with posteriormediastinoplasty was performed in 16 (4.4%) patients, in 14 of them--transhiatally. Complications occurred in 7 patients coloesophagopharyngoplasty was carried out in 52 (14.2%) patients with combined stricture of the esophagus and the pharynx, in 23 of them--simultaneously. Complications were in 28 (53.8%) patients. Intrapleural of coloesophagoplasty was performed in 51 patients. General hospital lethality was 3.3%. Long-term results were studied in 259 patients. Good results of esophagoplasty were seen in 135 (52.1%) patients, satisfactory--in 65 (25.1%), unsatisfactory--in 59 (22.8%) patients. Dysfunction of the artificial esophagus was seen in 22.0% patients, 12.7% patients underwent repeated reconstructive surgeries.

Adolescent↗

PubMedDate not supplied

Complications following gastric tube esophagoplasty in children.

Surgery in children with caustic esophageal burns, esophageal atresia or other esophageal disorders can be performed using gastric tube esophagoplasty. Between 1991 and 1999, a number of 41 such procedures have been performed in our department, using the original technique developed by Gavriliu. The results were assessed as good and very good in 83% of the cases, and fair or bad in the rest of 17%. We recorded 13 cases with significant complications, 4 of which ended with exitus. The paper present our experience in using gastric tube esophagoplasty and the management of the complications related to this procedure.

Adolescent↗

PubMed2004

[Esophagoplasty in patients with the "waning" stomach or without the stomach].

An experience with 48 intrathoracic esophagoplasties in patients with "waning" stomach or its absence is generalized. The results obtained show that scarry-ulcerous damages of the pyloroduodenal and cardioesophageal portions, local surgical procedures, gastrostomy included, are not considered as deterrent factors for using the stomach as the plasty material for esophagoplasty. For the resected stomach or its absence the small intestine should be preferred in the formation of the anastomosis within the limits of the thoracic cavity and large intestine--when putting anastomosis on the neck. A complete clinical effect was obtained in 45 patients. Three patients died (6.25%).

Adult↗

PubMedDate not supplied

Gastric esophagoplasty for esophageal carcinoma.

The 30 years experience includes 293 esophageal resections for carcinoma, completed with esophagogastrostomy at the thoracic or cervical level. Resections were performed according to the method of Garlock (73), Lewis (178), and Dobromyslov-Torek (36). This paper compares isoperistaltic esophagoplasty with whole or resected stomach (257) and antiperistaltic esophagoplasty with a tube from the greater gastric curvature (36). We will assess the choice of an esophageal substitute, the creation of esophagogastric anastomosis, and the functional consequences of surgical intervention.

Anastomosis, Surgical↗

PubMedDate not supplied

[The morphofunctional status of the isoperistaltic gastric transplant for esophagoplasty].

Thirteen patients with carcinomas of the esophagus underwent one-stage operations--extirpation of the esophagus without thoracotomy with simultaneous esophagoplasty using isoperistaltic gastric tube made of the greater curvature of the stomach, in posterior mediastinum with esophagogastrostomy in the neck. The morphofunctional state of the gastric transplants was investigated at early and late periods (for 8 months) after operations. The reduction of blood in the transplants to 40% of the initial, deterioration of acid production, depression of the motility, ischemic atrophy of mucosa and increased fibrosis in submucosa were revealed. Nevertheless satisfactory results of the isoperistaltic tubular esophagoplasty were obtained in 77% of patients in early periods and in 54% of the patients during the first year after operation.

Esophageal Neoplasms↗

PubMed2005

[Esophagoplasty using modified sleeve-type intrathoracic anastomosis].

Anastomotic leakage due to loosening of sutures is the frequent cause of lethality. To prevent such complication, a sleeve-type esophago-enteric and esophagogastric anastomosis was used. Its design eliminates the major cause of failure--the basic sutures running through the soft muscular wall of the esophagus. The new anastomosis was used in ca. 42 patients: Lewis operation (24), proximal resection of the stomach and distal thoracic part of the esophagus and adjuvant intrapleural esophagoplasty with the distal end of the stomach (8), gastrectomy with resection of the distal thoracic part of the esophagus and concomitant intrapleural esophagoplasty with small intestine (S.S.Yudin) (10). Postoperative complications were reported in 18 patients (42.9%); lethality--11.9%. No leaking esophageal anastomosis was registered.

Adult↗

PubMed1991

[One-stage total and intrapleural esophagoplasty in cancer and benign esophageal strictures].

The authors compared the results of one-stage intrapleural (114 patients) and total esophagoplasty (214 patients). The immediate postoperative results are better in total esophagoplasty both in carcinoma and in benign strictures of the esophagus. Incompetence of the esophageal anastomosis is much less dangerous on the neck than in the pleural cavity. The authors recommend wider performance of total plastics of the esophagus with its replacement by an isoperistaltic gastric tube.

Adult↗

PubMed1990

[Use of the sigmoid in esophagoplasty].

The authors worked out the indications for and the technical aspects of subtotal and total esophagoplasty with the left half of the colon together with a segment of the sigmoid colon. The described method allows the formation of an iso- or antiperitaltic graft of any length, in patients who underwent right hemicolectomy also. The operation was conducted on 54 patients with a mortality rate of 1.9%; 9 of them had been subjected earlier to unsuccessful esophagoplasty with the right half of the colon, which terminated in necrosis of the graft.

Burns, Chemical↗

PubMed1995

[Enteral tube feeding of patients after esophagoplasty].

A method for enteral catheter feeding is suggested. It was applied in 60 patients after esophagoplasty. The main group consisted of 23 females and 37 males aged from 18 to 68 years. Esophageal carcinoma was observed in 31, burn stricture of the esophagus 18, and other benign diseases of the esophagus in 11 cases. All patients were subjected to extirpation of the esophagus with one-stage posteromedial esophagoplasty in 57 patients with an isoperistaltic gastric tube and in 3 patients with the colon. The control group was formed of 20 patients who underwent the same operations. Inpitan, ovolact, and hypernutril were used for enteral catheter feeding. The catheter was introduced via the nasal passage and transplant into the proximal segment of the jejunum. The mixtures were administered in drops of 5 to 7 days after the operation. Only parenteral feeding was conducted in the control group. The disorders of the alimentary status were removed quicker in patients of the main group than in the control and the incidence of postoperative complications was less. Body weight and the nitrogen balance were restored within a shorter time in the main group patients and incompetence of the esophageal anastomoses developed in a lesser number of cases.

Adolescent↗

PubMed1994

[Choice of the method of forming an isoperistaltic graft from the stomach for total esophagoplasty].

An anatomical experiment was conducted on 50 cadavers of human adults and an acute experiment on 50 unbred dogs to choose the most rational method for forming an isoperistaltic graft from the stomach for total esophagoplasty. The anatomo-experimental study was concerned with the peculiarities of angioarchitectonics and the merits and shortcomings of some methods for lengthening gastric grafts. The macro- and microcirculation in the modelled isoperistaltic gastric grafts of various width and configuration was studied in the animal experiments. It was shown that the best gastric graft was an isoperistaltic tube measuring 2.5 cm at the base, formed by the authors' suggested method of angular division of the gastric walls above the pylorus, and with a dilatation in the proximal part (beginning 4 cm below the level of division of the main vascular arcade) up to 3.5 cm in size. When the length of the greater curvature of the stomach from the lower pole of the spleen to the pylorus, measured in mild stretching of the tissues (before mobilization of the stomach) is less than 20 cm it is advisable that the vascular connections in the hilus of the spleen are included in the nutrient-supplying pedicle of the graft to improve the supply of blood to its proximal segment. The method for formation of the gastric graft along a broken line was used in the clinic in 300 operations for extirpation of the esophagus with one-stage esophagoplasty. Necrosis of the graft was not encountered. Total postoperative mortality was 3%. It is concluded that wider introduction of this operation into clinical practice is expedient.

Animals↗

PubMed1992

Patch esophagoplasty with free forearm flap for focal stricture of the pharyngoesophageal junction and the cervical esophagus.

Focal stricture of the cervical esophagus can be caused by corrosive injury or irradiation or following esophageal reconstruction. For severe stricture that cannot be relieved by bougie dilatation, surgical correction should be done. Among the operations performed, the myocutaneous flap is considered the first choice. Patch esophagoplasty with a free flap is indicated in the following situations: (1) when the patient is a young woman, (2) when the patient is obese, and (3) following irradiation that renders myocutaneous flaps unreliable. For correction of focal stricture of the cervical esophagus, six patients underwent esophagoplasty with a patch of free forearm flap. In comparison with other methods, this approach is associated with less morbidity and a better aesthetic result. The patients started oral intake at 1 month. Only one patient had minor leakage, and this healed after conservative treatment. The skin patch inserted in the esophageal wall caused no problem in motility, and the patients could eat smoothly after surgery.

Adult↗

PubMed1986

Gastric tube esophagoplasty.

After a short review of the historical development of replacement of the esophagus, the possibilities, techniques, and results of gastric-tube esophagoplasty are discussed. Ten of 14 patients were followed up for 14 years, two were lost to follow-up and two died. Fistulas, anastomotic strictures, and also reflux could be treated successfully. A single perforation by endoscopy was surgically corrected. A peptic ulcer in the gastric tube was healed with antacid therapy. The gastric tube can be assumed to be a sufficient esophageal substitute. Long-term follow-up is still necessary.

Esophageal Atresia↗

PubMed1985

Anatomical study of retrosternal gastric esophagoplasties.

Five currently used procedures of gastric esophagoplasty were done in 5 groups of 14 embalmed human cadavers. These procedures were: whole gastric intrathoracic transposition (Kirschner's procedure) isoperistaltic gastric cone (Akiyama's procedure) isoperistaltic gastric tube (Rutkowski's or Lortat-Jacob's procedure); isoperistaltic gastric tube with resection of the lesser curvature; anisoperistaltic gastric tube with intrahilar splenectomy (Gavriliu's, Heimlich's procedure). Gastric morphometry and ascinding vascularization ability and quality of the vascular network were assessed. Injection of plastic dye was used to evaluate the vascularization of the grafts. In 13 out of 14 grafts, whole gastric transposition extended above the sternal notch, for a mean distance of 7.7 +/- 4.9 cm. This basic performance was significantly correlated to the dimensions of the greater and lesser curvatures and to the cardioxiphoid, sternal and hyosternal distances. Absent or poor injection of the distal arterial network, over a mean distance of 3.6 +/- 0.8 cm, was seen in all 14 grafts. Study of the isoperistaltic gastric cone demonstrated that the graft extended above the sternal notch in all 14 cases. The mean distance of the graft segment above the sternal notch was 5.0 +/- 3.0 cm. This basic performance showed a significant correlation only with the dimensions of the greater and lesser curvatures. Absent or poor injection of the distal arterial network of the gastric cones was seen in 9/14 cases, the mean length of the devascularized segment being 1.3 +/- 1.3 cm. Subsequent to resection of the distal zone showing poor vascularization, 13 out of the 14 isoperistaltic cones still extended above the sternal notch. The mean length of the segment above the sternal notch was 3.7 +/- 2.6 cm. All 14 isoperistaltic gastric tubes (without resection of the lesser curvature) extended above the sternal notch. The mean length of the segment above the notch was 15.1 +/- 7.1 cm. This basic performance showed a statistically significant correlation only with the minimum pylorodiaphragmatic distance subsequent to extensive Kocher's manoeuver. Of these 14 gastric tubes, 9 showed poor or no vascularization of their distal arterial network. The mean length of the poorly injected segment was 8.0 +/- 1.8 cm. Subsequent to resection of the poorly vascularized territory, 12/14 grafts were still found to extend above the sternal notch. The mean length of the segment above the sternal notch was 7.1 +/- 6.9 cm.(ABSTRACT TRUNCATED AT 400 WORDS)

Esophagoplasty↗