Blunt Dissection Of Esophagus Research Articles

Laparoskopische stumpfe Ösophagusdissektion mit abdomineller und mediastinaler Lymphknotendissektion beim Barrett-Karzinom

Esophageal resection has still a high morbidity and mortality. Minimal-invasive procedures don't have such complications. We describe a case of a patient with a Barrett-Carcinoma who was operated on by laparoscopic blunt esophageal dissection with abdominal and mediastinal lymph node dissection (tumor stage: pT3pN1 (2/16) G2). The postoperative course was without any complications.

Radionuclide transit in patients with colon interposition

To assess radionuclide transit in interposed segments of the colon, we examined 25 patients with colon interposition for benign esophageal disease. No such assessment has been reported previously. The most common indications for operation were esophageal strictures that developed after lye ingestion and reflux strictures not responding to other treatment. The operations were performed without thoracotomy by blunt esophageal dissection in 80% of the patients. There were 18 antiperistaltic and seven isoperistaltic colon grafts. A large-field gamma camera and computer system were used. Data were collected at time intervals of 0.5 second during the first 30 seconds and at intervals of 30 seconds up to 20 minutes. The 5% and 90% stomach filling times, times to 50% and 25% activity levels, and residual activity levels as a percentage of the maxima were calculated in the upper, middle, and lower thirds of the colon grafts and of the normal esophagus of 10 healthy control subjects. The examinations were performed with the subject in a sitting position. All parameters showed that emptying of the colon graft was markedly slower than that of the normal esophagus. The intra-abdominal third of the graft had a residual activity of 50.5% +/- 15.7% after 20 minutes' observation. No differences between antiperistaltic and isoperistaltic grafts were observed. Reconstruction with proximal cologastric anastomosis and a short intra-abdominal colon graft segments is suggested.

A CASE OF BARRETT ESOPHAGUS TREATED BY ESOPHAGEAL BLUNT DISSECTION WITHOUT THORACTOMY

A case of Barrett esophagus is presented. A 71-year-old man was first admitted to our hospital because of dysphagia. Two years before admission, he had complained of heartburn and epigastric pain. Endoscopy showed a hiatus hernia and gastric mucosa in the lower esophagus. Mucosal biopsy specimens revealed columnar epithelium extending upward, with no malignancy. Diagnosis of Barrett esophagus was made. He began receiving cimetidine, 800 mg/day, orally. Although the symptoms were relieved after the medical regimen, serial endoscopy showed no marked improvement but occasional ulcer formation in the columnar epithelial zone during these two years. On this admission, physical examination revealed an undernourished man in no acute distress. Laboratory studies disclosed mild anemia and mild restrictive pattern on pulmonary function test. Chest X-ray showed an old focus of tuberculosis and diffuse pleural calcification of the right lung. Upper GI series demonstrated stricutre of the lower esophagus without ulcer formation. With pulmonary complications taken into account, blunt esophageal dissection was performed without thoracotomy. The postoperative course was uneventful and the patient was discharged 40 days after surgery. Clinicopathological aspects of Barrett esophagus and its malignant potential are discussed. Blunt esophageal dissection without thoracotomy is considered a preferred treatment of choice.

Esophageal reconstruction for stenosis due to diffuse scleroderma. Utilizing blunt dissection of esophagus.

Blunt dissection of the esophagus and cervical esophagogastrostomy via a posterior mediastinal tunnel without thoracotomy was successfully performed in a patient with esophageal stenosis secondary to scleroderma. The larynx was, of course, preserved. This type of esophageal reconstruction is believed to be an effective and simple means of providing palliation in this difficult clinical situation, and is one of the good indications of utilizing blunt dissection of the thoracic esophagus.