ANTIREFLUX CERVICAL ESOPHAGOGASTRICANASTOMOSIS IN THE SURGERY OF ESOPHAGEAL CANCER
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Purpose: Development and introduction into clinical practice of the reliable and functionally valuable, simple in performance cervical esophago-gastric anastomosis after esophagectomy due to cancer of the thoracic site of esophagus resulting in reduction of the number of failure and cicatricial stenosis, decrease in pathological signs of pharyngeal and/orgastroesophageal reflux.Methods: Clinical investigation was performed on 212 patients with cancer of thoracic esophagus during the period from 2000 to 2008. Esophagectomy by trans-thoracic approach was performed on 33 patients, and trans-hiatus - on 179 ones. The one-stage esophageal plasty with isoperistaltic tube from the greater curvature of stomach, transposition of the graft through the bed of the esophagus removed (posteriomediastinal approach) and manual formation of the cervical esophago-gastric anastomosis (EGA). The patients were divided into 2 groups in relation to the type of cervical EGA formation: group 1 included 55 (25.9%) patients who were made cervical EGA end-to-end after esophago-gastrectomy during the period from 2000 to 2003; group II comprised of 157 (74.1%) patients were performed antireflux cervical EGA end-to-side developed in our center after esophagectomy from 2004.Results: Comparative analysis of the results of cervical EGA formation between groups showed sharp reduction of the number of suture failures from 23.5% to 6.1%, of EGA stricture from 33.3% to 4.4%, of reflux-esophagitis from 72.5% to 3.4%, of aspiration complications from 21.6% to 1%, respectively. The lethality was 6.6%. The cause of death was not related to the methods of EGA formation and its complications in all the cases.Conclusions: The formation of the cervical EGA according to the developed technique allowed avoidance of severe complications of the suture failure in anastomosis, minimization of the frequency of stenosis, avoidance of marked gastrointestinal reflux in the long-term period. The formation of gastro stoma in the oral end of the graft gives opportunity to begin early enteric nutrition, to avoid oral nutrition for a long period, the manner of its formation prevents leakage of the stomachic contents beside the tube and skin maceration, without necessity of stoma closing with special methods.
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