[Choice of the method of forming an isoperistaltic graft from the stomach for total esophagoplasty].
An anatomical experiment was conducted on 50 cadavers of human adults and an acute experiment on 50 unbred dogs to choose the most rational method for forming an isoperistaltic graft from the stomach for total esophagoplasty. The anatomo-experimental study was concerned with the peculiarities of angioarchitectonics and the merits and shortcomings of some methods for lengthening gastric grafts. The macro- and microcirculation in the modelled isoperistaltic gastric grafts of various width and configuration was studied in the animal experiments. It was shown that the best gastric graft was an isoperistaltic tube measuring 2.5 cm at the base, formed by the authors' suggested method of angular division of the gastric walls above the pylorus, and with a dilatation in the proximal part (beginning 4 cm below the level of division of the main vascular arcade) up to 3.5 cm in size. When the length of the greater curvature of the stomach from the lower pole of the spleen to the pylorus, measured in mild stretching of the tissues (before mobilization of the stomach) is less than 20 cm it is advisable that the vascular connections in the hilus of the spleen are included in the nutrient-supplying pedicle of the graft to improve the supply of blood to its proximal segment. The method for formation of the gastric graft along a broken line was used in the clinic in 300 operations for extirpation of the esophagus with one-stage esophagoplasty. Necrosis of the graft was not encountered. Total postoperative mortality was 3%. It is concluded that wider introduction of this operation into clinical practice is expedient.
Chernousov
A F
AF
Cherniavskiĭ
A A
AA
D000818:Animals; D002102:Cadaver; D004285:Dogs; D004944:Esophagoplasty / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications; D013270:Stomach / Q000637:transplantation*
Vybor sposoba vykraivaniia iz zheludka izoperistal'ticheskogo transplantata dlia total'noĭ ézofagoplastiki.