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Summary. The most formidable early postoperative complications of Lewis esophagogastroplasty (EGP) is the failure of esophagogastroanastomosis (EGA), and in the late period — stricture of EGA, in some patients there are functional disorders. The aim of the study. Assess the treatment of complications of EGP using minimally invasive methods. Materials and methods: The results of 150 operations for cancer of the middle and upper thoracic esophagus with the imposition of high EGA were analyzed (65 used cervical EGP). X-ray endoscopic techniques are used to treat patients with complications. The functional results of EGP using esophageal manometry and pHZ monitoring were also evaluated. Results and discussion. When applying EGA on the neck was significantly higher incidence of failure of the anastomotic sutures, which was associated with impaired blood supply with increasing length of the graft. Surgical tactics in case of failure of the EGA on the neck was to open and drain the deep space of the neck, conducting a transnasal tube for feeding into the stomach — there were no fatalities. Surgical tactics in case of failure of intrapleural EGA, which took place in 4 cases, consisted of drainage of the empyema cavity and conducting a transnasal tube for nutrition in the initial parts of the small intestine under X-ray video surveillance. In the treatment of failure of intrathoracic anastomoses there was 1 fatal case. At strictures of EGA which took place at 24 patients, performed balloon dilatations under X-ray video control. In 2 patients with the phenomena of pylorospasm performed balloon dilatation of the pyloric pulp under X-ray video control. In general, patients who underwent EGP showed good and satisfactory functional results, but in some patients there were functional disorders that were transient in nature. Conclusions: The use of clinically developed methods of esophagogastroplasty can reduce the number of failures and strictures of anastomoses. At insufficiency and strictures of an esophagogastroanastomosis, and also at a hypertonia of pyloric pulp X-ray endoscopic methods are highly effective and low-traumatic. |
