Intestinal Interposition Research Articles

Dysphagia Due to Anastomotic Stricture and Angulation in a Patient with Intestinal Interposition for Benign Disease, Treated with Removable Esophageal Stent

Dysphagia Due to Anastomotic Stricture and Angulation in a Patient with Intestinal Interposition for Benign Disease, Treated with Removable Esophageal Stent

Prise en charge des lésions urétérales iatrogènes

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.

Corrosive esophagitis in children.

We evaluated the outcome and optimal management of corrosive esophagitis in 24 children (male:female=8:16, mean age 5.0+/-5.4 years old, ranged from 15 months to 18 years of age) from January 1984 to July 2001. In 20 patients this was the result of accidental ingestion, 4 were suicide attempts and 15 patients (63%) were below 3 years of age. The ingested substances included alkali (n=17, 71%), acid (n=6, 25%), and neutral detergent (n=1, 4%). The "dumpling alkaline oil", a traditional food additive used in Taiwan, was the most common culprit in this study. A total of 9 patients ingested the dumpling alkaline oils, which comprised 38% of the total 24 patients and 53% of the 17 alkaline ingestion accidents. Of the patients 21 (88%) suffered from esophageal injury, and 15 among these 21 patients developed esophageal strictures. Esophageal strictures occurred in all patients with second or third-degree burns. Of these 15 patients with esophageal strictures, 9 (60%) received endoscope-associated dilatation and 6 (40%) underwent an operation (esophagectomy and intestinal interposition). The 9 patients who did not develop esophageal strictures had good body weight gain without feeding difficulty (functionally normal recovery). On the other hand, among the 15 patients with esophageal strictures, 9 patients had functionally subnormal recovery and 6 patients had poor recovery with either frequent feeding difficulty or growth retardation. In conclusion, accidental ingestion of alkaline oil is the most common cause of corrosive esophagitis in Taiwan. The degree of burns correlated with stricture formation.

Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer.

A secure lymphadenectomy in a laparoscopically assisted gastrectomy performed for gastric cancer is required because of the high prevalence of lymph node metastasis. A surgical technique for laparoscopic gastrectomy with lymph node dissection and reconstruction using a conventional circular stapler is reported. Forty-nine laparoscopically assisted gastrectomies with lymphadenectomy (47 distal and two total gastrectomies) were performed using devices for retraction of the stomach and laparoscopic ligation of arteries, which were developed to ensure secure dissection of lymph nodes. Reconstruction by Billroth I or intestinal interposition using a conventional circular stapler was performed through a small incision through which the specimen was removed. When submucosal invasion was suspected (n = 16), the lymph nodes along with the common hepatic artery were also dissected through the same incision. The operations were performed without serious complication. None was converted to laparotomy, and there were no deaths. Metastatic lymph nodes were seen in perigastric nodes and nodes along the left gastric artery in five cases. In five of the 49 patients the macroscopic diagnosis of depth of invasion was underestimated. A technique of laparoscopic gastrectomy with lymph node dissection for early invasive gastric cancer is described. A definitive answer concerning the appropriate level of lymph node dissection and the role of laparoscopic gastrectomy in the treatment of more advanced gastric cancer remains to be defined.

Therapy of cervical esophageal carcinoma.

Surgical treatment of cervical esophageal cancer is influenced by special problems arising from the anatomical characteristics of this organ. The cervical and thoracic extension of these tumors makes an extensive lymphadenectomy necessary, and radical resections often may only be achieved by laryngectomy. The extent of the resections performed determines the type of intestinal restoration by gastric or colonic interposition and small bowel transplantation. The patient's voice may be preserved by means of tracheopharyngeal shunts with intestinal interposition. The advances of radiation therapy and chemotherapy will enable less extended resections with greater rates of laryngeal preservation.

CONCOMITANT MODIFIED BLADDER NECK CLOSURE AND MITROFANOFF URINARY DIVERSION

We describe a modification of bladder neck closure for managing urinary incontinence in children. In 11 patients with intractable urinary incontinence that persisted after multiple failed surgical procedures we performed modified bladder neck closure with construction of a catheterizable continent conduit. Mean followup is 3 years. All patients were continent after the procedure and none had a fistula or urinary leakage. One patient required stomal and conduit revision, and bladder stones in 3 necessitated endoscopic removal. We recommend this modified technique of bladder neck closure as an option for managing urinary incontinence in a complex group of children because it allows the achievement of continence with minimal morbidity.

P.31 Nutritional evaluation after extensive intestinal resection and colon interposition in rat

P.31 Nutritional evaluation after extensive intestinal resection and colon interposition in rat

A CASE REPORT OF MULTIPLE GASTRIC CARCINOID WITH HYPERGASTRINEMIA

This paper presents a case of multiple gastric carcinoid with type A gastritis and hypergastrinemia with a review of the literature. A 40-year-old woman visited the hospital because of belching lasting for several months. She was found to have 3 polyps and multiple granuler lesions at the proximal stomach by gastroscopy. Those polyps were diagnosed as carcinoid lesions by cytology and histology. She had no symptoms or signs of typical carcinoid disease. In laboratory examination, hypergastrinemia, 21000pg/ml, was found. Total gastrectomy with reconstruction by means of intestinal interposition method was performed on July 5, 1991. On pathological findings, more than 400 carcinoid miriary nests, based type A gastritis, were found. Serum gastrin level was normalized after the operation. This case suggested that multiple gastric carcinoid lesions might be precipitated by chronic atrophic gastritis accompanied with hypergastrinemia.

気管ならびに食道の先天性疾患と外科治療

Among various anomalies related to the trachea and esophagus, atretic and stenotic lesions are the most common and challenging objects in pediatric surgery. Tracheoplasty with the costal cartilage grafts is the treatment of choice for the extensive congenital stenosis of the thoracic trachea. We treated 4 cases of tracheal stenosis with this technique. Observation for following 2 years suggests that this technique is useful for such extensive lesions as an end-to-end anastomosis is not indicated.One hundred and thirty seven cases of esophageal atresia were treated at our institute with an overall mortality rate of 38%. Primary or staged end-to-end esophageal anastomosis was performed on 94 patients with a 20% mortality rate, whereas jejunal or colonic interposition was indicated for 13 patients with a mortality rate of 30%.The cause of stenosis of the esophagus was fibromuscular hypertrophy in 20, bronchial remnants in the esophageal wall in 7 and the ectopic gastric mucosa in 2 of our series of patients. Esophagoesophageal anastomosis was a possible procedure when the length of resection of the esophagus was limited to within 2.5cm. Intestinal interposition was, however, required when the esophagus was resected 3.5cm and more.

One-stage reconstruction of the hypopharynx using myomucosal tongue flap and dermal graft

Reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy provides a one-stage procedure to reconstitute the food conduit. A myomucosal advancement tongue flap forms the anterolateral walls, and the dermal graft forms the posterior wall of the reconstruction. Sixteen patients underwent reconstruction by this method. Thirteen required total laryngectomy and total pharyngectomy for extensive carcinomas. Two other patients who had previous laryngectomy and hypopharyngeal recurrence had pharyngectomy and repair by tongue flap and dermal graft. A third patient required laryngopharyngectomy following recurrence after supraglottic laryngectomy. No postoperative deaths have occurred. Anteriolateral defects of up to 8 cm in size can be reconstructed providing the neck can be flexed. Larger posterior defects superior to the eustachian tube can be closed. In two patients minor fistulas developed which closed spontaneously. One other patient had a delayed wound dehiscence and infection with fistula and carotid blowout. The patient had undergone previous surgery and radiotherapy. Deglutition was good to excellent in most patients. Three patients required esophageal dilatation with resolution. Cinegraphic studies have demonstrated the tongue to propel a bolus and to modulate speech which shows this repair to create a dynamic conduit. One patient had difficulty in swallowing because the left hypoglossal nerve was resected. Seven patients were alive with no evidence of disease 2 to 30 months postoperatively. Four patients who were free of their original disease died from other causes. Four patients died from original disease 5 to 23 months postoperatively. At present, one patient is alive with disease. Tongue flap and dermal graft provide a reliable and one-stage reconstruction following laryngopharyngectomy and should be considered as an alternative to distant flap and intestinal interposition reconstructive procedures.