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PubMed2003

Lengthening technique for long gap esophageal atresia and early anastomosis.

BACKGROUND/PURPOSE: The treatment of long gap esophageal atresia remains a major surgical challenge. Whereas many approaches have been used for this problem, none are ideal. The authors used a technique originally described by Dr John E. Foker and accomplished early repair in 3 infants with long gap atresia. METHODS: Three infants with esophageal atresia underwent thoracotomy shortly after birth and had a long gap preventing primary anastomosis. External traction sutures were placed on each esophageal pouch and exteriorized through the thoracic wall. The esophageal ends were approximated 1 to 2 mm daily by traction on the sutures. Anastomosis was performed when the 2 ends came together. RESULTS: Three infants were included (31, 34, 37 weeks gestation, weights 1.38 kg, 1.9 kg, and 2.3 kg, respectively). The esophageal gaps were 3, 5, and 4.5 cm, respectively. Definitive anastomosis was performed at 14, 17, and 10 days, respectively. Two patients had anastomotic leaks that were treated conservatively. One patient had an esophageal stenosis that required dilatation. CONCLUSIONS: This technique allowed rapid esophageal lengthening in these 3 cases and led to early repair of long gap esophageal atresia, avoiding the need for a prolonged hospitalization or eventual replacement as well as long-term swallowing difficulties.

Anastomosis, Surgical↗
PubMed2001

Laparoscopic gastrostomy: results of 121 patients over 7 years.

Laparoscopic gastrostomy was introduced in various technical variants 7 years ago. However, larger series and long-term results of these new methods are still lacking. In a prospective study, laparoscopic gastrostomies were performed by two institutions in 121 patients (88 men, 33 women; mean age, 58.3 +/- 11.16 years [range, 24-82]) with esophageal stenosis in locally advanced hypopharyngeal or oropharyngeal carcinoma, incurable esophageal carcinoma, and cerebral dysphagia. Operating time was 40 +/- 22 (range, 10-160) minutes. Procedure-related mortality was 0%, early mortality was 1.6%, the overall intraoperative complication rate was 7.4%, and the early complication rate was 9.9%. During a cumulative usage time of 1086.2 months, the complication rate in 1000 usage days was 0.8, and the stoma infection rate was 0.65. Laparoscopic gastrostomy is a reliable method for safe and economic establishment of enteral nutrition, even in patients for whom long-term nutrition by gastrostomy is expected.

Adult↗
PubMed1989

Palliative and curative surgical therapy of malignant stenoses of the esophagus and cardia.

Between January 1967 and July 1986, 171 patients with malignant stenosis of the esophagus and cardia were subjected to curative or palliative surgical treatment. Specifically, there were 84 primary esophageal carcinomas, 5 cases of malignant esophageal stenosis caused by an extra-esophageal malignant tumor (inter alia bronchial carcinoma), and 82 primary carcinomas of the cardia. The average age of the patients as a whole was 63.7 years, and the sex ratio (male:female) was 4.0:1. In 18 esophageal carcinoma patients and 21 patients with carcinoma of the cardia curative resection was possible, but in 132 patients merely palliative surgery was performed, most frequently esophageal intubation and gastrostomy. The specific operations with a curative objective performed upon the esophageal carcinoma patients were abdominothoracic esophageal resection with upward displacement of the stomach (n = 16) or interposition of a colonic segment (n = 2), whereas in the patients with carcinoma of the cardia, proximal resection was performed in 13 cases, either subtotally or as a cardiofundectomy, and total gastrectomy in 8 cases. For the subsequent reconstruction of the passage the interposition of a jejunal segment was most frequently used. The clinical mortality for the curative resections was 33% for the 18 esophageal carcinoma patients and 9.5% for the 20 patients with carcinoma of the cardia. The long-term survival rates are depressing: of the patients who underwent curative resection 47.6% were still alive after one year, 28.6% after 2 years and 14.3% after 5 years. Of the patients treated only palliatively on account of an already advanced stage of the tumor, 91.5% died within the first year; only 4.9% of patients from this group were still alive after 2 years.

Adult↗
PubMedDate not supplied

[Bucco-pharyngeal and esophageal localizations in Crohn's disease].

A case of upper esophageal stenosis associated with pharyngeal lesions in Crohn's disease is reported. The esophageal stricture was intractable by endoscopic dilatation. This patient was managed successfully by total esophagectomy. The left colon was used to replace the esophagus through a posterior mediastinal route. Histologically, the lesions were epithelioid granulomas with ulcerative fissurations and submucosal lymphoid nodules and were suggestive of Crohn's disease involving the upper esophagus and pharynx only. Similar cases involving only the upper digestive tract with pathologic proof have not yet been reported in the literature.

Crohn Disease↗
PubMed1982

Esophagocardioplasty with gastric pouch. An experimental study in dogs.

In 18 dogs esophagocardioplasty was performed through an abdominal incision with a gastric patch taken from the minor curvature of the stomach. In four dogs the mucosa was removed from the gastric patch and in six dogs a Nissen fundoplication was done. The dogs were observed for 1 year. All dogs showed macroscopic and microscopic signs of esophagitis with ulcers; three had esophageal perforation and two dogs had esophageal stenosis. We found that gastric patches with peptic acid secretory mucosa in dogs cause grave esophageal lesions.

Animals↗
PubMed2006

Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns.

OBJECTIVE: We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns. METHODS: Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation. RESULTS: There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux. CONCLUSION: The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.

Adolescent↗
PubMed1986

[Double Y pharyngocolostomy. An original procedure].

An original procedure is presented which involves cervical anastomosis after colic esophagoplasty, allowing double drainage of pharynx. As a function of permeability of esophagus, two variants are described: "esophagopharyngocolostomy in Y" and "double pharyngocolostomy in Y". The operation is performed as either a one-stage (immediate) or, more frequently a two-stage procedure: to correct tracheal reflux after high pharyngocolic anastomosis (with oropharynx); in low end-to-side esophagocolic stenosis with colic tube in excess and in narrow caliber sclerous esophagus. This method was used in 6 cases of post-caustic esophageal stenosis with very good long-term results. The method is an anti-reflux procedure which also ensures prophylaxis of recurrent stenosis of the cervical anastomis.

Adult↗
PubMed1977

[Surgical attitude in pre-pyloric stenosis due to corrosive substances. Intravascular segmental antrectomy in Y-V. Report of 80 cases (author's transl)].

The author reports 80 cases of gastric stenosis due to caustic substances, of which 20 were limited only to the stomach and 60 were accompanied by esophageal stenosis. In most cases (78.8 p. cent), the site of the gastric stenosis was antral, pre-pyloric and the duration of onset was, on average, 3 weeks. Surgical treatment depended on the extent of the corrosive lesions. In limited antral stenosis, we carried out antrectomy with gastroduodenal anastomosis. In pre-pyloric stenosis situated 3 to 5 cm from the pylorus, the author recommends conservation of the non-functioning pylorus by double pylorotomy and anastomosis with the whole of the border of the stomach, describing a personal procedure named intravascular Y-V segmental antrectomy. The criterion which decides the proximal border of the resection, should be the appearance of the gastric mucosa, the section should pass immediately above the caustic ulceration. In extensive gastric stenosis (more than 75 p. cent) of the stomach and in evolutive corrosive lesions, we recommend Y-shaped jejunostomy, of Maydl type. In post-caustic pre-pyloric stenosis we operated on 76 cases out of 80 with 3 deaths (3.9 p. cent mortality). In 25 patients we carried out esophagoplasty about 6 months after the accident. We preferred restrosternal isoperistaltic coloesophagoplasty by Kelling's procedure. To increase the circulation through the left colic artery and marginal artery, we ligatured the middle colic artery and right colic artery at the same time as the gastrostomy.

Adult↗
PubMed2002

Collis-Nissen procedure in patients with esophageal atresia: long-term evaluation.

A subset of patients with esophageal atresia (EA) have an associated short esophagus and require an antireflux procedure. The Collis-Nissen procedure, which consists of a combination of Collis gastroplasty and Nissen fundoplication, is considered an option in such conditions. The long-term results of EA patients undergoing this procedure have rarely been reported. The results of the Collis-Nissen procedure were examined in four EA patients with follow-up for an average of 9 years. The Collis-Nissen procedure was conducted concurrently with segmental esophageal resection for an associated congenital esophageal stenosis close to the esophagogastric junction in two postoperative Gross type C patients (7 months, 2 years), as an antireflux operation in a postoperative Gross type A patient with an unreducible sliding hiatal hernia (10 years), and with primary repair of EA in a Gross type A patient with a long gap (4 months). There were no significant complications except minor anastomotic leakage and an anastomotic stenosis that required postoperative dilation. Significant reflux was negative, as shown by an upper gastrointestinal study and scintigraphy. Limited esophagitis just above the esophagogastric junction was observed in a Gross type A patient with a long mediastinal gastric segment. Swallow-related pressure reduction at the wrapping cuff was detected by manometric examination. The Collis-Nissen procedure is a useful option for treating EA patients who require esophageal lengthening and control of gastroesophageal reflux.

Esophageal Atresia↗
PubMed2001

Ingestion of caustic substances and its complications.

CONTEXT: Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested. OBJECTIVES: To analyze the complications in patients who ingested caustic substances and correlate them with the amount of caustic soda ingested. DESIGN: Retrospective study. SETTING: University hospital, a referral center. PARTICIPANTS: A total of 239 patients who ingested caustic soda. MAIN MEASUREMENTS: The amount of granulated caustic substance ingested was measured as tablespoonfuls and the following complications were analyzed: esophagitis, esophageal stenosis and progression to cancer, fistulas, perforations, stomach lesions, brain abscesses, and death. Stenosis was classified as mild, moderate or severe according to the radiological findings. RESULTS: We observed an 89.3 % incidence of esophagitis; 72.6 % of the cases involved progression to stenosis and 1 per cent died during the acute phase. Stenosis was mild in 17.6 % of cases, moderate in 59.3 % and severe in 23 %. The incidence of stenosis was 80.8 per cent in women and 62.5 % in men. The incidence of stenosis was 46.9 % in the group that ingested "fragments" and 93.6 % in the group that ingested one or more tablespoonfuls of caustic substances. Among subjects who ingested one or more tablespoonfuls, 32.2 % developed lesions of the stomach-duodenum, whereas the ingestion of "fragments" was not sufficient to induce these lesions. There was no correlation between the intensity of lesions of the esophagus and of the stomach. Progression to cancer of the esophagus occurred in 1.8 % of cases, death during the chronic phase in 1.4 %, perforations in 4.6 %, fistulas in 0.9 %, and brain abscesses in 1.4 %. CONCLUSIONS: The complications were related to the amount of caustic soda ingested. Small amounts caused esophagitis or stenosis and large amounts increased the risk of fistulas, perforations and death.

Adolescent↗
PubMed1992

Brain abscess after esophageal dilatation for stenosis.

The case is presented of a 28-year-old female with a brain abscess after esophageal dilatation for stricture, secondary to an acute necrotizing esophagitis. Other causes of brain abscess were excluded. To our knowledge this is the first documented case of brain abscess after dilatation for esophageal stricture in adult life. Some reports in the pediatric literature have been published previously.

Adult↗
PubMed2004

The usefulness of videomanometry for studying pediatric esophageal motor disease.

PURPOSE: Abnormalities in esophageal motor function underlie various symptoms in the pediatric population. Manometry remains an important tool for studying esophageal motor function, whereas its analyses have been conducted with considerable subjective interpretation. The usefulness of videomanometry with topographic analysis was examined in the current study. METHODS: Videomanometry was conducted in 5 patients with primary gastroesophageal reflux disease (GERD), 4 with postoperative esophageal atresia (EA), 1 with congenital esophageal stenosis (CES), and 1 with diffuse esophageal spasms (DES). Digitized videofluoroscopic images were recorded synchronously with manometric digital data in a personal computer. Manometric analysis was conducted with a view of concurrent esophageal contour and bolus transit. RESULTS: Primary GERD patients showed esophageal flow proceeding into the stomach during peristaltic contractions recorded manometrically, whereas patients with EA/CES frequently showed impaired esophageal transit during defective esophageal peristaltic contractions. A characteristic corkscrew appearance and esophageal flow in a to-and-fro fashion were seen with high-amplitude synchronous esophageal contractions in a DES patient. The topographic analysis showed distinctive images characteristic of each pathological condition. CONCLUSIONS: Videomanometry is helpful in interpreting manometric data by analyzing concurrent fluoroscopic images. Topographic analyses provide characteristic images reflecting motor abnormalities in pediatric esophageal disease.

Adolescent↗
PubMed1980

An evolution of therapy for mucocutaneous candidiasis.

Chronic mucocutaneous candidiasis is a relatively uncommon form of candida infection, and can be found in patients with primary deficiencies of their immune systems. When such infection occurs in patients with non-lethal immune deficiences defects of chemotaxis or cellular immunity can be found. In addition, significant endocrinopathies may occur, particularly involving the parathyroid and adrenal glands. A number of therapies have been devised for the treatment of chronic candidiasis, and have included both local and systemic medications. The most useful of these in the past have included the polyene antibiotics -- most notably, nystatin and amphotericin B. Antifungal activity has also been demonstrated clinically with the use of 5-fluorocytosine (a fluorinated pyramidine) and clotrimazole (a synthetic imidazole derivative). However, long-term therapy with medication has been required, and re-emergence of symptomatic infection has occurred when medications have been stopped. More recently, immune reconstitution with transfer factor has been employed in the treatment of patients who have been found to be anergic to candida. Such treatment in conjunction with chemotherapy has indicated that effective patient remissions can be obtained in those patients who develop and maintain cell-mediated immunity to candida. Twelve patients with chronic mucocutaneous candidiasis are profiled. Sites of involvement in the head and neck included the skin and hair (9), ears (9), nose (4) and throat (12). One patient had candida laryngitis, while five patients had evidence for esophageal disease. Of this latter group, one (a 5-year old boy) developed esophageal stenosis which required gastrostomy and retrograde esophageal dilatations. Nine patients were found to be anergic to candida. In these patients, systemic chemotherapy (as amphotericin B or 5-fluorocytosine) was used to induce remissions of disease and transfer factor was given to induce reactivity to candida. By so doing, topical or oral medications (utilizing miconazole, clotrimazole and nystatin) were found to suffice in maintaining effective local control of infection.

Amphotericin B↗
PubMed2002

[Stent placement in patients with benign esophageal strictures].

The aim of the study was to evaluate results of esophageal stenting for non-neoplastic strictures. A lot of studies proved esophageal stenting for neoplastic strictures to be a safe and effective method of palliative treatment. However, esophageal stenting for non-neoplastic diseases is a matter of controversion. At the Clinic of Thoracic Surgery of Vilnius University during period of 4 years esophageal stenting for non-neoplastic reasons was performed in 12 patients. After the evolution of the results, it was concluded that self-expanding stents were not suitable for the treatment of non-neoplastic esophageal stenosis. Best results have been achieved implanting into esophagus salivary bypass tubs.

Adult↗
PubMedDate not supplied

Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture.

OBJECTIVE: To present a technique for the treatment of complete esophageal stenosis in the post-radiation patient that may be applied to selected patients with obstructing stenoses. STUDY DESIGN: A case report of the treatment of a post-radiation esophageal web. METHODS: A review of the patient's history of treatment and a discussion of reported treatment options. RESULTS: A complete obstruction of the cervical esophagus was diagnosed in a patient after chemoradiation for a hypopharyngeal carcinoma. Retrograde esophagoscopy through the patient's percutaneous endoscopic gastrostomy tube site aided visualization and perforation of the obstructing tissue. Subsequent dilation has allowed the patient to resume oral intake of a regular diet without restrictions. CONCLUSION: Combined direct laryngoscopy with retrograde esophagoscopy represents a viable alternative to more extensive approaches for recannulization of selected obstructing esophageal stenoses.

Carcinoma, Squamous Cell↗
PubMed1991

Swallowing function following hypopharyngeal reconstruction with the pectoralis major musculocutaneous flap.

Swallowing function was studied in three patients following the pectoralis major musculocutaneous reconstruction of the hypopharynx and cervical esophagus after extensive resection for hypopharyngeal cancer. Fluoroscopy and endoscopy revealed the formation of a sphincter-like ring at the proximal end of the remaining intact esophagus. This ring may act to prevent reflux from the lower esophagus, although its sphincteric power is weak. Manometric testing showed that no swallowing pressure was produced in the reconstructed gullet; therefore, bolus propulsion at the pharyngeal stage occurs mainly by gravity. Follow-up studies on swallowing indicate a minimum length of the suture line of 11 cm in order to prevent esophageal stenosis due to anastomotic stricture at the distal mucocutaneous junction.

Aged↗