[Modern esophageal surgery and late functional results as equations with several unknowns--Hungarian Academy of Sciences Doctoral Thesis].
Using the same surgical method and anatomically ideal primary healing, the functional results could even be different later. Trying to identify various factors being responsible for the above differences, 637 patient's data, who underwent previous oesophago-gastric surgery between 1985-2005, were analyzed. Biochemical, histological and electrophysiological examinations had been evaluated. Developing hypertrophy-like metabolic changes and enteric ganglionitis as morphological alternations of LES muscles induced by GERD may be reasons for complaints after antireflux surgery. The marking of Z-line with endoscopic clips followed by an immediately upright contrast study and substractional evaluation is appropriate for detecting true short esophagus. Open surgical procedures are justified even in the new millennium in cases when the patient already underwent previous upper abdominal operations - due to an increased risk of injury because of adhesions - in cases of primarily recurrent paraesophageal hernias after an unsuccessful open and/or laparoscopic reconstruction, as well as in cases of reflux with complications. When adenocarcinomas of the gastro-oesophageal junction are examined preoperatively, the ratio of the performed catabolic - AMAN, CB, and DPP I - enzymatic activity of the tissue sample from the tumour and adjacent intact mucosa within 2 cm of the tumour may have a prognostic value even in the preoperative examination period, and neo-adjuvant treatment should be considered in these group of patients. The patients' post-operative complaints and symptoms change during the post-operative period and correlate with the parameters of the myoelectric and contractile activities of the "Akiyama stomach". Tachygastria seems to be the major pathogenetic factor involved in the contractile dysfunction. Gastro-jejuno-duodenal interposition represents an adequate 'second-best' method of choice if technical difficulties emerge with jejunal or colon interposition following limited resection of the oesophagus performed due to early Barrett's carcinoma or non-dilatable peptic stricture.
Altorjay
Aron
A
Fejér Megyei Szent György Kórház Sebészeti Osztály, 8000 Székesfehérvár, Seregélyesi út 3. altorjay@mail.fmkorhaz.hu
D000230:Adenocarcinoma / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D001471:Barrett Esophagus / Q000503:physiopathology / Q000601:surgery; D002299:Cardia; D004935:Esophageal Diseases / Q000150:complications / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery; D004939:Esophageal Perforation / Q000503:physiopathology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome