Transposition Of Stomach Research Articles

A RARE CASE REPORT OF SMALL BOWEL OBSTRUCTION WITH A GIANT HIATUS HERNIA

Introduction: Hiatus hernia refers to transposition of stomach through esophageal hiatus of diaphragm. There are 4 types of hiatus hernia. Generally patients with hiatus hernia are asymptomatic but may present with gastrointestinal or respiratory symptoms. Here we report a case of a patient with intestinal obstruction who was diagnosed with giant hiatus hernia incidentally. Case Report: A 70 yrs old female patient presented to the emergency department with complaints of abdominal pain, vomiting and inability to pass stool and atus. Patient had no co-morbidites. examination patient's abdomen was distended and non tender, previous operative scar was present .On auscultation peristalsis was heard in the lower left thorax and reduced breath sounds on left side. Methods And Tools: Hematological and biochemical work up were done along with radiography, ultrasonography and CECT( abdomen + pelvis) which established the diagnosis of giant hiatus hernia. Patient was taken up for surgery after explaining the relatives about the condition and the need to do the surgery. Discussion: Giant hiatal hernia is responsible for 0.3–15% of all hiatal hernias. There are various approaches to operate a patient with a giant hiatus hernia. Results: Radiological investigations were conrmatory to establish the diagnosis of hiatus hernia and hence, patient was taken for surgery after this. Conclusion: All the asymptomatic cases of giant hiatus hernias should be operated to avoid further complications.

Outcomes of esophagoplasty in children (a 14-year experience)

Introduction. The authors analyze the effectiveness of one-stage esophageal plasty in children. They consider -from different points of view- possible problems accompanying such surgical interventions as well as complications and high mortality.Material and methods. The article summarizes outcomes after esophagoplasty in 61 patient who were at the surgical department of the Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan) during 2006–2020 (June). Among them there were 24 (38%) children after the first stage of cervical esophagostomy combined with gastrostomy in esophageal atresia; 34 (56%) children had decompensated post-burn esophageal stricture and after ineffective conservative treatment; 1 (2%) patient had esophageal varicose veins because of the portal hypertension syndrome with formed cicatricial esophageal stricture and with high risk for bougienage; 2 (4%) patients had an extended peptic stricture of the esophagus as a complication of gastroesophageal reflux disease (Barrett esophagus).Results. One-stage coloesophagoplasty was performed in 44 (72%) children. Gastroesophagoplasty with the whole stomach transposition was performed in 12 (20%) children with esophageal atresia; in 3 (5%) - replacement for post-burn cicatricial stenosis and in 1 (2%) - because of varicose veins in the esophagus.Conclusion. The choice of esophagoplasty technique should be individualized depending on patient’s general state, on pathological lesions in the esophagus as well as on previous surgeries on the abdominal organs, if any.

USING THE STOMACH IN SURGICAL CORRECTION OF ESOPHAGEAL ATRESIA WITH VACTER-ASSOCIATED MALFORMATIONS IN CHILDREN

Surgical treatment of diseases and congenital esophageal defects in children is one of the most difficult parts of pediatric surgery. The vast majority of orthotopic and heterotopic esophageal reconstructions in children falls on atresia or complications of chemical destruction.The present case illustrates the construction and implementation of a treatment plan for a child with esophageal atresia combined with microcephaly and VACTER-associated anomalies. In this case, the transposition of stomach into the thoracic cavity was used for esophageal atresia correction with a good result. Conclusion:1. Realization of esophageal shift by transposition of the stomach is one of the possible solutions to the complex problem of esophageal atresia correction associated with multiple malformations.2. Use of this technique creates optimal conditions for tube feeding in children with central nervous system disorders and violations of swallowing.

Laparoscopic retrosternal bypass for corrosive stricture of the esophagus

Surgical management of corrosive stricture of the esophagus entails replacement of the scarred esophagus with a gastric or colonic conduit. This has traditionally been done using the conventional open surgical approach. We herein describe the first ever reported minimally invasive technique for performing retrosternal esophageal bypass using a stomach conduit. Patients with corrosive stricture involving the esophagus alone with a normal stomach were selected. The surgery was performed with the patient in supine position using four abdominal ports and a transverse skin crease neck incision. Steps included mobilization of the stomach and division of the gastroesophageal junction, creation of a retrosternal space, transposition of stomach into the neck (via retrosternal space), and a cervical esophagogastric anastomosis. Four patients with corrosive stricture of the esophagus underwent this procedure. The average duration of surgery was 260 (240-300) min. All patients could be ambulated on the first postoperative day and were allowed oral liquids between the fifth and seventh day. At mean follow-up of 6.5 (3-9) months, all are euphagic to solid diet and have excellent cosmetic results. Laparoscopic bypass for corrosive stricture of the esophagus using a gastric conduit is technically feasible. It results in early postoperative recovery, effective relief of dysphagia, and excellent cosmesis in these young patients.

Sternotomy after retrosternal esophagogastric anastomotic disruption: a case report

Disruption of cervical esophagogastric anastomosis after retrosternal stomach transposition remains a dangerous complication. We report a case of cervical gastric disruption after retrosternal gastric transposition in a 36-year-old man that required sternotomy for reanastomosis. After sternotomy, gastric mobilization was possible, in order to gain sufficient length for a new cervical esophagogastric anastomosis.

Radical resection for cancer of the hypopharynx and cervical oesophagus with repair by stomach transposition.

The results of 58 consecutive cases of pharyngolaryngo-oesophagectomy and pharyngogastric anastomosis are presented. The Grey Turner technique is used, but modified by adding bilateral chest drainage established by guidance from below the diaphragm and a jejunostomy. The immediate postoperative therapy management of hypocalcaemia with calcium gluconate and long term control with calciferol is described. An overall 3-year survival rate of 29 per cent has been obtained. Seven patients survived longer than 7 years, the longest living over 10 years. The authors conclude that, with careful management this technique is within the compass of competent surgeons with good facilities and should be the surgical treatment of choice for these difficult tumours.

Barrett esophagus--esophageal carcinoma: surgical therapy

Barrett's oesophagus is an acquired condition that occurs as a consequence of gastrooesophageal reflux. Continuous exposure of the Barrett's epithelium to gastric juice may lead from a low-grade to a high-grade dysplasia and subsequently to an invasive adenocarcinoma. Therefore, the first goal of treatment for patients with Barrett's oesophagus is the prevention of reflux to eliminate the risk of a progression to dyplasia and cancer. In contrast to medical treatment antireflux surgery restores the low oesophageal sphincter, abolishes reflux of gastric contents into the oesophagus and ends the repetitive injury to both the metaplastic and normal oesophageal mucosa. In case of Barrett's carcinoma of the distal oesophagus a radical transhiatal oesophagectomy with systematic abdominal and mediastinal lymph node dissection is the procedure of choice. After forming a gastric tube the reconstruction is done by a transposition of stomach through the posterior mediastinum and a cervical anastomosis. Because of substantial complications and long-term side effects the need for extensive resection in patients with early tumour stage (pT1) is questionable. Therefore, a limited resection of distal oesophagus and proximal stomach with two-field lymphadenectomy and jejunal interposition is an attractive alternative in early Barrett's carcinoma providing a low morbidity and mortality and resulting in a 90% chance of cure in patients without lymph node metastasis.

Mucosectomia esofágica no tratamento do megaesôfago avançado: análise de 60 casos

A ressecção do esôfago sem toracotomia vem sendo utilizada com maior freqüência, nos últimos anos, para as afecções benignas, sobretudo no megaesôfago avançado. A vantagem dessa via de acesso é a de evitar o comprometimento da dinâmica pulmonar, mas, entretanto, podendo haver abertura da pleura, com o conseqüente hemopneumotórax, além da potencial agressão a outros órgãos mediastinais com morbidade pós-operatória muitas vezes expressiva. Por sua vez, no megaesôfago avançado, a esofagite de estase predispõe à instalação de carcinoma. Com base nessas considerações, foi proposta, previamente em animais e cadáver humano, a retirada da mucosa-submucosa do esôfago, mediante sua invaginação completa, sem toracotomia. Os resultados satisfatórios estimularam a continuação nessa linha de pesquisa, iniciando-se a experiência na área clínica. Assim, o presente trabalho teve por objetivo demonstrar o resultado do pós-operatório imediato, a técnica de retirada da mucosa do esôfago pelo descolamento submucoso, conservando a túnica muscular intacta no mediastino. O procedimento foi realizado pela via cervicoabdominal em 60 pacientes portadores de megaesôfago graus III ou IV. Efetuou-se a reconstrução do trânsito grastrintestinal transpondo o estômago pelo mediastino posterior, por dentro da túnica muscular esofágica ou pela via retroesternal. O estudo permitiu concluir: 1) a ressecção da mucosa pelo plano submucoso, mediante a invaginação, mostrou ser de execução simples e viável em 98,4% dos casos; 2) ausência de sangramento, no intra ou no pós-operatório imediato, cuja origem fosse do leito da túnica muscular esofágica remanescente ao nível mediastinal; 3) baixa incidência de complicações pleuropulmonares - 5,0%.

Function of the intrathoracic stomach as esophageal replacement.

AbstractThe emptying, acid secretion, mucosal changes, and duodenogastric and gastroesophageal reflux of the intrathoracic stomach were studied in 12 patients together with the clinical course 6–12 months after esophageal replacement.Although no pyloroplasty had been performed, the emptying of a semisolid meal from the interposed stomach was significantly accelerated compared to the controls. No residual food was found in the stomach at endoscopy after an overnight fast. Distinctly accelerated gastric emptying correlated with spontaneous duodenogastric reflux across the denervated pylorus.Despite a persistent acid secretion of the vagotomized intrathoracic stomach, no pathologic gastroesophageal reflux and no esophagitis were found proximal to the cervical anastomosis. Gastric biopsies mostly revealed mild gastritis of the antral mucosa, whereas metaplasia was rare. The intrathoracic stomach does not need a drainage procedure to facilitate semisolid emptying. Postoperative reflux esophagitis is prevented by complete intrathoracic stomach transposition with cervical esophagogastrostomy.

Immediate reconstruction using visceral transfer after pharyngolaryngoesophagectomy for advanced hypopharyngeal cancer.

The management of 32 stage IV cases of cancer of the hypopharynx was reviewed retrospectively with a view of selecting a pertinent treatment modality to ensure low morbidity and high survival and evaluating the applicability of abdominal viscera as a reconstructive measure after total pharyngolaryngoesophagectomy. Three methods of visceral reconstruction have been used at this hospital, viz., reversed gastric tube, colon interposition, and stomach transposition. In our experience, the gastric pull-up is more reliable. The success rate of oral alimentation of 20 gastric pull-ups was 95% and the mortality rate was 5%. The overall 3-, 5-, and 10-year survival rate was 37.5% (12/32), 38% (8/21), and 30% (3/10), respectively. Preoperative irradiation gave a 3-year survival rate of 40% (8/20) for T4 N0-3 cases.

Analysis of the methods of pharyngoesophageal reconstruction.

During the period 1972-1982, 84 pharyngoesophageal reconstructions were performed on 82 patients (10 benign lesions and 72 malignant lesions) by the Department of Otolaryngology, Mount Sinai Medical Center, New York. The overall mortality for the series was 10%, with postoperative complications developing in the majority of patients and swallowing accomplished in 61%. The most successful method of reconstruction was stomach transposition (92%), followed by cervical flap repair (68%). The least successful methods were the use of the tubed deltopectoral and pectoralis major myocutaneous flaps, colon interposition, and jejunal autografts (40%-50%). The pertinent literature is reviewed and the reported mortality, morbidity, indications, limitations, and success rates for each method of reconstruction are analyzed and compared with the present series.