1,721,012 research outputs found
Surgical treatment of reflux stricture of the oesophagus
No full textThe choice of surgery in patients with reflux-induced oesophageal stricture remains controversial. From 1976 to 1990, a total of 65 patients underwent fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten), total duodenal diversion (four) and oesophageal resection (15). The postoperative mortality rate was 5 per cent (three patients): necrosis of the colon transplant in two patients and acute pancreatitis in one. The median follow-up was 25 (range 6-120) months. After conservative surgery, the median number of dilatations per patient per year significantly decreased (P < 0.001). Nine patients (25 per cent) complained of persistent or recurrent symptoms after standard fundoplication and six required reoperation. Clinical results were satisfactory in patients who underwent Collis fundoplication, total duodenal diversion and oesophageal resection. It is concluded that the causes of failed fundoplication are irreversible stricture or persistent gastro-oesophageal reflux; the latter may be caused by inefficacy or deterioration of the partial fundoplication wrap. A subtle degree of oesophageal shortening is probably underestimated in such patients and this may explain the better results obtained with the Collis fundoplication. Total duodenal diversion is a good therapeutic option in patients who have undergone previous oesophagogastric surgery. Oesophageal resection should be reserved for patients with tight strictures unresponsive to dilatation or those with scleroderma, multiple previous operations or severe dysplasia in Barrett's oesophagus
Splenic abscess: the rationale for selective non-surgical treatment
No full textAbscess of the spleen is a potentially lethal condition, with an associated mortality rate of 60-100% in untreated patients. Splenectomy, or in selected cases, surgical or percutaneous drainage of the abscess is currently considered the standard of care. So far, conservative treatment with antibiotics has been successfully employed in four patients, including the two reported herein. The importance of a careful clinical and ultrasonographic monitoring for best therapeutic decision-making in patients with splenic abscess, is stressed
Repair of a postesophagectomy bronchogastric tube fistula with polyglactin mesh supported with a muscle flap
No full textAbstract
A bronchogastric fistula is a very rare complication of transthoracic esophagectomy. We report a case of bronchogastric fistula after transthoracic esophagectomy caused by dehiscence of the staple line in the gastric tube, with subsequent erosion into the right main bronchus. The patient was managed successfully in two surgical stages. First, the bronchial defect was repaired using a polyglactin mesh covered by a serratus anterior muscle flap. Two months later, the esophagogastric continuity was restored with colon interposition
[Physiopathology of the pharyngo-esophageal junction and indications for myotomy of the upper esophageal sphincter]
No full text[Surgical therapy of diaphragmatic eventration in adults: indications, technique and choice of approach]
No full textThe Authors report their experience in the surgical treatment of eventration of the diaphragm in the adult. Symptoms and indications for surgery are evaluated and compared with data reported in the literature
Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication
No full textFrom 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia
Thoracoscopic removal of benign tumours of the oesophagus
No full textThoracoscopic excision of an oesophageal leiomyoma was successfully performed in 4 patients. The tumours were enucleated easily without intraoperative complication. A patient in whom the muscular layer was not sutured after removal of the myoma presented with a pseudo-diverticulum one year after the operation and required a thoracotomy for resection. This new procedure which reduces the operative trauma and postoperative pain and allows quick recovery, is described
Surgical treatment of cervical anastomotic leaks following esophageal reconstruction
No full textCervical anastomotic leaks occurring in the early postoperative period after esophageal reconstruction are life-threatening complications, with a mortality rate similar to that of intrathoracic leaks if the posterior wall of the anastomosis is affected. Prompt diagnosis and aggressive surgical treatment is vital. The surgical procedures commonly used are often inadequate or unsatisfactory because of the difficulties encountered in the subsequent reconstruction. Twelve patient with an early cervical anastomotic leak following elective esophageal surgery were treated using an original surgical technique which allows diversion and simple delayed reconstruction of the anastomosis without risk of late stricture. Uncontrolled mediastinal sepsis accounted for the three deaths of the series and occurred in patients with a leak of the posterior anastomotic wall in whom definitive surgical treatment was delayed
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