[The prevention and treatment of complications after esophagogastrostomy by intraluminal elastic circular ligation].
To summarize our experience on the handling of postoperative complications of esophagogastrostomy by elastic circular ligation (IECL), 176 patients with esophageal or cadiac carcinoma underwent esophagogastrostomy by IECL with absorbable supporting tubes were reviewed. There were 7 cases of postoperative complications with an incidence of 3.97%. Of which, anastomotic leakage in 3 patients, recurrent laryngeal nerve paralysis in one and chylothorax in one were cured by conservative measures; one patient with hiatus hernia was treated by reoperation, and another patient died of right tension pneumothorax. After the causes of complications being analysed, improved operative procedures are recommended. (1) The esophagus must be dissociated up to the apex of pleural cavity when anastomosis is performed above the aortic arch, so as to have the lower end of the supporting tube at least 0.5 cm higher than the arch. (2) The supporting tube must be wrapped with the gastric wall and avoid suturing through the esophageal mucosa layer. (3) When the anastomosis is performed below the aortic arch, reconstruction of the hiatus should be done with the esophagus moved forward to prevent the thoracic aorta from eroded by the supporting tube. (4) If the residual gastric volume is less than one-third of normal, the above-mentioned operation procedures can not be employed.
Zhang
Y
Y
Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang.
Du
X
X
Chen
L
L
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002299:Cardia; D004938:Esophageal Neoplasms / Q000601:surgery*; D004946:Esophagostomy / Q000009:adverse effects*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000601:surgery*