International Medical Journal, Vol. 24., Iss. 2, 2018, P. 19−22.
MECHANICAL INVAGINATED ESOPHAGOGASTRIC ANASTOMOSIS IN PREVENTION OF POSTOPERATIVE COMPLICATIONS IN PATIENTS AFTER ESOPHAGUS RESECTION
A. A. Shalimov National Institute of Surgery and Transplantology of National Academy of Medical Sciences of Ukraine, Ukraine
Esophagus reconstruction after esophagectomy remains one of the main problems in esophagus surgery, and the reliability of anastomosis with the esophagus is topical to the present day, since anastomosis failure is attributed to the main causes of lethal outcomes of operations. Mechanical suture using staplers, which are constantly being improved, is becoming increasingly popular in esophagus surgery. With regard to postoperative complications of the anastomosis, evaluation of the stapler technique gives equal or better results than the manual one. The mechanical (stapler) method of formation of the esophageal−gastric anastomosis is associated with reduction in the operation time, it reduces the incidence of anastomosis failure as compared with the manual method, but increases the risk of developing postoperative strictures. A new method of formation of esophagogastroanastomosis was proposed and postoperative complications were assessed: its failure in the early postoperative period and the number of cicatricial strictures of this site at different stages after esophagectomy. To evaluate the advantages of forming invagination mechanical esophagogastroanastomosis in patients with esophageal diseases after resection the patients operated for malignant tumors of the esophagus and gastroesophageal junction were examined. They were performed Lewis operation and Osawa−Garloc operations. The number of postoperative complications from anastomoses was assessed: the number of cases of esophagogastroanastomosis leakage in the early postoperative period and the number of cases of esophagogastroanastomosis scar stricture 3, 6 and 12 months after surgery. Esophagogastroanastomosis leakage in the study group was not recorded, in the comparison group, the leakage of EGA was detected in 2 patients. The number of postoperative strictures of the esophagus 3 months after surgery was lower in the study group and was 10 %, in the control group −30 % of cases. Six months after surgery, the number of esophagogastroanastomosis strictures in both groups increased and amounted to 15 % and 40 % of cases, respectively. Twelve months after the operation the number of cases of esophagogastroanastomosis stricture remained lower in the study group and amounted to 20 % of the cases with respect to 40 % of cases of esophagogastroanastomosis stricture in the comparison group. Thus, it was established that formation of invagination mechanical esophagogastroanastomosis in the conditions of esophagus resection reduces the number of cases of esophagogastroanastomosis leakages and the number of esophagogastroanastomosis stricture, which proves its higher reliability and effectiveness in comparison with the classical mechanical anastomosis.
Key words: esophageal cancer, esophagogastric anastomosis, anastomosis stricture, anastomosis failure.