A Useful Esophageal Replacement for Benign Disease

Thc R,cvcrscd Gastric 'I'ubc H,cvisitcd: AUscfuB Esophagcal
~leplaccnH~nt for Benign Disease
f'vLlilOcl XiIllCI1CS, 11I, MD, f<ACS, Rcinaldo O. Silva, MO, Luiz F. Vicira, MD,
Grcgorcic,
i\drianél
I ]uspilal
MD
eit; l3as!: ur th!: Distrilo
I\llhollgh
spallillg
a ee::tury,
hebal,
10llg csopllagcal
I'rcqucnl
13rasilia, DF, 13raziL
dcrcds
rOlllplkaliolls
using a rcverscd
rclcgalcel
luhc 01' lllc gl'calcr
rurvalul'c
lias heen availahk
lllc lIIetlloel to tlle sllell' rOI' 111I1('11
01' llle pel"Íoel. This
1'01'ncarly
slllely n'visils
the
fl'ehlliqlle
in lhe nHHlcrn settillg. Thl' esophaglls,
pllls or lIIinlls, lhe phary"x
was n'plare!!
ill X{) patielltl's
IIsin~~ a
44 paticllf.s witi,
reversed ~~:lstrk tuhe. I'atientcs
with rallrcr wcrc cxduded.
Sixly-Iivc had rauslk
SICllosis, illduding
:lrllie perforation
aliei 15 wilh hlll"ns ol'the pllary"x alld stolllarll. I<'ollow-up was (WO 1II0lltlls to 15 years. lIsing rrilel"Ía
sugge,';ted hy Viskk
et ai, 44 palicnts
(5S.6(1<,) had 110 sYlllptollls; 20 (26.6(1;',)
had mild eOlllplaints,
and eighl
iildividuals
(10.6 %) had rr'cqllcnl (li' scvcrc symploms.
Thc opcralioll
itsclf rallscd thl'cc dcalhs (3.7%). A n'\'l'J'sl'd
gastrk tubc ean saf'cly ,"cplarc lllc clltirc csophagus and pllaJ'ynx . Wilh S5.2% 01' 75 patiellts cvaluatcd
sllOwing ~~ood
to cxrc::ellt
reslIlts and hospital mOl'tality 01' 3.7%. Wc hclicvc this opcration
crn lakc its plarc alongsidc
01' olher
cstalJlished tcdllliqlles.
(S 1\111.1Th"ra('
Til!:
lósihility
ur r!:placil1g
grc;ller
clll'v:illIre
dui I1g
:llla lomic
aml evel1ll1ally
II:Jipnll
I()():'1 wit!l
heg:11l ill
sllldies
SlIhseqllel11 stlldies
lhe esuphaglls
ill
Ikck
dog
were carried
l!le
:11ll1Carrcll
(I).
cadavers
011 !lllmal1 specimel1s,
il1 patiellls
wil!l
hy .Iiallll
expecl:iliol1s.
111 :1
lill:ralllre
()c!lsl1er
hy
slll'vivors
t!le
1<(14 review
:IIHI
01' al1lrt!loracic
geal slrictllrc:;
(2),
s!lort
01' l!le
()wel1s
t!lere
esop!lagoplasty
alld associates
over
greatcr cllrv:rlllre
10 lhe
10 I'urm
skill
:r1l:lslomosed
gaslroslomy
10 ll1e cervicai
esop!laglls.
colollic
aml
lolal
were
K()
Torol1to
r:rlhcr
l'lIrt!lcr
110
patiellls
Ire:lled
wit!l a reverscd
curvalllre.
(ú)
Patients
helligll
(41 WOlllel1 :lIld:V)
01' l!lc
csop!laglls
!lis
(K
patiell(s
!Jelligl1 :llld 111:11igllalltc1íscasc (I().
Cervical
1.2(;';,)
procedures
I'rcsclrlcd ill Ihc l'"sln
"I'Thma('il'
Sessi,," "I' lhe Thirly
S"rgl',,"s.l':tilll
l\tidll'SS 1('l'lilll 1(''1"esls I,) Ill.
SIIIN
Sl'lillgS,
!lad
perl'ormed
('I\,
.1:111
,'II·h'h
2, I')'):;.
rv1:III"ci Xillll'III'S
l)11I7 Cj 12 Casa 21, 71:; 1:;·1211, Brasili:l, Ill',
I'h,,"(' & Fax: 111I.:;:;J, 1.:;77.,122:;;
I'ollowillg
ill
rel1l:lillillg
paliellls
endoscopy
(11=3),
slríclure
Blasil
E'1I1:Ii1: Xill1~'llcs(lI)nl.grar.(,"Il1.hr
22
ill
l!le illSllll,
!lad
(lI'
illcllldil1g:
01' 1l1e
lhe
(11=4),
Ilasogaslric
perrural iOIl
alld
plcl,r:r1
Icsscr Cllrv:J1IIIT.
Iralllll:r
The
surgic:d
ligalioll
drail1age
lhe
di!alcd.
sever:d
Thc
diaglloslic
I racl1eoesophagea 1 fislllla
al'tcr prolollged
spol1la IlCOllS
(e)1998 IJY lhe Asociación SlIdatnericana de Cirllgia Torácica
heillg
cOlllil1l1i(y,
.illllclioll,
space aml gaslroslolllY
l'irsl AIIIIII:ti rvicclillg "I' Ihl'
rUllr cases (.'1:'1(}-:,)
wl1ik
gaslroesop!lageal
S"I'il'lv
hllly
perruraliol1
eXc!lIsíol1
I'ur
~) 10 7() YC:IIS). Six!y
I'or perruralioll
wil!l
ph:lrYl1x
h:ld esopl1age:r1 slel1o:;i.s :IS :111
for l!le procedure.
were rekrred
il1ili:l! experiellce wil!l :r reversed gaslric 11Ihe, :r series
whic!l 110Wal1lolll1ls to more t!lall 7()() cases I'or bol!l
cOl1dilioll:;
I <)7K alld JlIlIl: I ()<kl. Tl:e
diseasc betweell JlIly
imlicatioll
(9) pllblished
111 Il1is
11I!:ll), lI!1dl'!\VC!I!
alld/ur
olle p:iliellls
al1d Georgescll
wil h adv:11I1;Igcs
t,lkel1 rrol1l Il1e grealcr
:lver:lge age W:IS 3!J years (rallge
wíll10llt sllcess (7,K).
lhe
10 he ali accept;lhlc
csop!l:lgc;r1
tllbc
IlIClll:r1 sllldies hy I<ay (1()4J) :rl1d SWellSOI1(1<)44) Icd to
iJlIl
wil!l
ill childrClI
aml Methods
replacemel1l
experi-
:11](1
at a persol1:r1 scries 01'
ciillic:rl
11119:'11 Gavril\lI
hol!l
illlerposilioll.
I'ur iJelligll
gaslric
I~ighly paliellls
l!lall
lI~;e 01' Il1is Iypc 01' esop!l:rge:J! replacemelll
lhe liler:illIIe
gastric
p:lper we luoked relrospeclivcly
11Ibe Il1al was iJrollg!lt
a
(I ()) reviewed
11I!Jeesop!lagoplasly
:Ivailablr
a lwo slage teclll1iqlle based 011 the prillciplr
01' reversíllg:r
!lis lot:r1 experiel1ce 01' ú7 C:ISCSill I ()7S (11).
lhe s:rmc prm:edl1n:
mel hod 01' esophagea I replacelllelll
01'
ror esop!la-
rrom
presellled
1<):'1:'1ekscribed
alld adlllls alld rOlll1d the oper:ilioll
lIsil1g a revcrsed gaslric tllbe (:'1).
111 1941 Carler
described
opera IiOI1 ldl
ill
reversed gastric
(:1) al1d Lulh!:iss!:11 (4). Owil1g tu a !lig!l ral!: ur
compl ic:iI íOI1S, huwevcr,
I kil1llic!l
11119K3 ()'COllllur
live allimals
Sllrg. I '1'1,';; 1:22·2(1)
(11=:\),
CIIII1!Jatillll (11=,1).
hrol1c!lial-esophagea
I
S I\rn J TllOfaC Surg
XIMENES ET'?\L
ESOPHAGEALREPLACEMENT
1008;122-26
I'islllla, one each (Figme I). If a gaslroslolllY was
prcscnl, I()()(hnl of a líqllid elicl is giwn every Ihree
hOllrs whilc awake in ordcr 10dílale lhe slolllach .
esophagus. Fom or five applications of a linear slaplcr
(1'1,(' :'i:'i) are fíred along lhe luhe, carel'ully following
lhe grealer cllrvalllre 10 achieve oplilllal luhe Icnghl.
Ikfore lhe last applícalion, lhe tube is placed on lhe
anlerior chesl wall and, if necessary, lhe gaslroesophage:i1jllnclion is severcd in order 10 gain a kw
cenlilllelers lllore. ;\ rllnning layer of 4-() vycril ís
placed along lhe g:lslric 11Ihe,:Ind on lhe gaslric side
as well. Pyloroplasly is not done. Previous hariulll
swallow and rigid endoscopy evaluales lhe prox illla I
fooel passage. 1l is ílllporlanl nol 10 conslrllcl lhe
anastolllosis in scar. The sile of lhe anaslolllosis of lhe
Caustic Stenosis
(without perfora tion)
21 cases
Caustic Stenosis
(with perforationl
44 cases
/
,
,
gaslric 11Ihein lhe neek Illay he done at any püinl IIp 10
lhe pharynx. The esophageal gasl ric an:lslolllOsis is
performed ín Iwo 1:lyers of lllucosa 10 lllllcosa :111(1
serolllllsclllar-Io-advenlicia
mllsclIlar
Iayer
wilh
inlerrllpled I'ille 4-ll vycril or fine silk sllture (I ~). !Il ali
cases lhe tllbe was brollghl IIp throllgh a sllhslernal
1I1I1IIel. !lolll en<ls 01' lhe slernull1 :11'(; líl'lcel wílll
5%
Trauma
IGSW-KNIFE)
4 cases
1,2%
Bcnign BEF
I case
rctraclors wilh I'orce and lhe [uhe is c1rawn IIp al'ler
lyillg ils <Iislal ell(l wílh a heavy slilch in a lllhe. The
Oll1enlllllJ is wraped loosely around the gaslric lllhe, so
lllat it wíll lie llver lhe anaslol11osis in llle Ileck. The
1,2%
L~!.?~Ál
3,7%
3
skill only is slllllred !ollsely wilh Ileilher dr:lills in lhe
Ileck nor abdomen. No Ilasogaslric tllhe is t1sed. ;\
kedíng jejllllosl(lIlJY or gasl rusloll1Y is placed.
Endoscopy
Pose NG Tube
cases
IDiagnostlcl
3 cases
.__3,7% l
1'lIslll/l('I'III;I'I'
Benign
3 cases
TEF
I-"ig.l-
1/IIIiCtl/ilJ//s
"i,I,{"//s,·.
I.c·g,m/s:
11'II1'!tc'I}('SIJII/ItI,t;('(I/
c
',11
,/Jilllg"I"
./i,r
(,slJl,I/IIgm/
(;.\'IV=
.fISllt///;
N(;=
gllll
r('/'I//('ml('/II
s!tol
//II,l'IIglI.l'/ril';
./"r
II'IJIIII";
C"re
'I'he palienl is ellcouraged 10 swallow saliva,
oral fecdillg is lIsllally wilhhold ulllil postoperalive
7, whell a harílll11 swallow IS givcll 10 veril'y
p:IIcIlCY 01' lhe 11Ihe(Figllre 2). 011 d:IY Ihree,
keding is slarlcd,
hmig//
n,,'I-'=
/11,,'1-'= hl'll//I'!till1-
./iS/IIII1.
hllt
day
lhe
11Ibe
Rcsults
.\I((I;SI;('((lll/lI/lys;s
The slatislical an:t1ysis was verified hy lesting lhe
elilcrcllce IJclween lwo proporlíons (12). Slalíslical
significance was elcrined as a 1i value 01'Icss lhan ().Wi.
Thc reslllls werc evalualed t1sillg lhe (1I1odil'ied)
qlleslionaire suggeslcd by Visick ('I'alJle I) (22).
SlIrgic{{/II'('!Jllic/1I1'
TI/h",
The operalion is perforllled wilh Iwo teall1Sworking
sinllillaneousiy, one in lhe Ill:ck aml lhe olhcr in lhe
aIJdolllcn, If lhe splcen is 10 IJe relllowel Ihis ís lhe first
InalHllIver 10 be perfol'llled laking care to preserve the
shorl gaslríc vesscls. (splcneclolllY w:is done in (L'i
palienls). The grealcr olllenlulll is dissecleel oul frolll
lhe lransverse lllesocolon and lhe excess is rellloved
I.
Mot/i/iet/
\lisick
c/il/iml
gl'llt/il/g
Ciralic I. No sYl1lptOIlJS,110lIe:lrlhlll'Il, reglll'git:llioIl !li'
dyspiJ;lgia.
Ciralic 2. Mild, m:casioIla!SYllJp!OIllS,110trealllleIlt 11
Cl:dcd.'
Mild hearlhurn, rcgllrgilatioIl m dysphagia,
C;rade :I. Mme fl'CqllCIlI sevcrc SYIllPIOIllS, rcqlliring
llledicatioIl or iIll'rcqllcnl dilalalioIl, disahling rcrlllx
sYllJp!OllJs.
(;r;ldc 4. SYlllplonls no! illlprovcd or worsc IhaIl
prcopcralively and / 01'rcopcralion rcqllircd.
bcrore heing wraped arollnd lhe 11Ihe_The righl
gaslroepiploic arlery is dOllbly
ligated 2 - 4 Clll
proxilllal to the pylorlls. ;\ 2 Clll opcning is made in lhe
;Intrlllll, whcre a large hore tube (4ll 10') is plaeed along
lhe grc:ller cmvalllre in order 10 calihrale lhe new
23
XIMENES ET AL
ESOPHAGEALREPLACEMENT
S Am J Tllorac Surg
1998:1:22-26
withoul dilTiculty.
norm;i11y.
GRADE
hut one were :Iblc
1\11
eal
10
DEFlNITION
o
1.
.,
.J
Nosymptoms
Mild. occaslonal symptoms.
no trea tment needed
More frequen t or severe symptoms
.
requirlngmedlcation
or infrequent dilatatlon
4
Symptoms
not Improved or worse than
proeopera tively and/or
reopera tion required
• Viste'- AH: Al,,!,(Jiuf~d ,oGjerrl
CpeltHiOm'
(eu
. De!l1el!s(!r
mt'OtIJ'ement
gosutcromy. R('n~'.\
IJI(tl. tÚ1lt:t'! 1948.1;50~·!l1~
Johr1son LF':
Tfle
el'/Jr(Jatlort
C'f
~()~
I~prlt
T~,
S (IJn N Amtr
1!!'J~l,l"
Qr'td lheo éo'H"b;t'V'l
of ~(7WC~$Ophll~eallflf1v~
fO PO(leJlt management.
ar
1976;56;~9·53
Grade
Grade
I
H cases
i"igllr('
2.
Jlllrilllll
/'('/1/11''('11/('111.Nole
.I'lvlII/mv
011('
I!I,· illlrll-lIhtlolllillll/Jwrlioll
IV(,1'k
3 -
1111<'1' (,SOJI/IIIgca/
J.'ig.
(Ir l//(' IlIh,·.
g/l.l'lric
/le.l'lI/I.I'
.•
3 cases
01' l/I<' "soJ"liIg('{I!
/'C'fllt/{'('/I/('/1I
II'illl
11 /','I','I'S""
/11/"'.
Sixleell 11011r:lllllollli/.l:d
paliellls wl10 had Il1e
operalioll Pl:rforJlll:t1IJt.:twl:l:n 15 ycars allll six IIl0nll1s
were evalllaled wilh Te ()<) M Pertecl1llc!:Ile. The
We I'llund 44 palienls in grade I, lwenly in grade 2,
eighl grade J and lhree I'ailures (Figure J).
The palienls wilh more freC]ucnt symploms rec]uireel
112 receplor anlagonisl, propping IIp lhe head lll' lhe
beel anel eliel. Qnc palicnl hael a duodcnal ulccr seen aI
cneloscopy, which healcd wilh
mcelicalioll. Nu
u!ceralion was sccn in lhe gaslric lube. In I'iftecn
esophageal lrallsil liml: was ISJ) secolllls (lIorl11al
K.K+/- () sec) wilh partial rc!enlioll ill Ilte dislal Ihird.
No rcrlux was demollslralcd ill Ihis gruup (Figures 4
aIlel S).
palienls, lhe lube was anaslomosed in lhe uropharynx
anel' parlial remova 101'lhe Ihyroid carlilage, lhe hYllid
boue, or holh. Under lhese circunslances we pass a
heavy silk lhough lhe moulh, down lhe nellesophagus
and oul Ihrough lhe gaslroslolllY 10 I'acililalc elilalalion,
should Ihal bccomc ncccssary. In (his subsel 01'
palienls, Ihree werc a complele I'ailure. In oneol' Ihem
lhe luhe hecame gangrenous and was removecl hy a
c( )/lI! l/i
('({ / ill/ls
Fifleell COlllplicaliolls were seell. I.'istula was lhe
mosl COllll1101lalltl occurn.:d ill ciglh cases (IO'Yr,). 111
lhis sllbscl cighl paliellls developed I'istula lú!lowed I>y
stcnosis. Five 01' thcse had dilatalioll 011 severaI
occasiolls :Illd were cured alld Iltree reqllired ccrvicai
reanastoJllosis. ()Ile was done IS years :t1'tcr IIte
silllple t racl ion Ihrough lhe neck incision, wil houl
suhsequenl inl'cclion in lhe cervic:i1 are;, or mcdiasl inum. 1\ dda ycd colon bypass solved lhe problelll.
Thcre were Iwo olhers who had laryngeal anel
lracheal slcnosis. One was ncver dec:lIlulated and lhe
origillal procedllre. ":Illpyelll:l :Il1d respir:llory distress
syndl'(lIl1l~W:lSseCl1ill Iw() paliclIls. Fivc paliellts died,
Ihrl:e while ill Ilw hospil:ll :Il1d Iwo lale ones. 1\11 t1e:lllts
were ill palienls who had lhe splcell removed, !>ul Ihis
I'illlling was nol slalistica!ly signil'icanl whell c()l11p:lred
wilh lhe Ihose (1);\1kl:pl Ilte splel:1l (j! = 0.1). 'i'W() lale
eleallts Wl:re due one 10 lung callcu' and Ilte olheI'
pro!>ahly to I\ids inl'cclion.
01heI' had lhe slcnosis successl'ully rcpaired. Five
palients required anlreclolllY 10 excise damaged
slolllach. I.~veu so, lhe gaslric tuhe
was elevaled
24
S AIT1
J
XIMENES ET AL
ESOPHAGEALREPLACEMENT
TI10raC Surg
1(lHO; 1:22-26
,
".,
"
l' MIN/FR '
, MAX
ESOPHAGUS
TI=. 1.5 SEC
%
COUt
E:::céHAGUS=
74.6
lT:::; ..·:õ·EC
~-vJy.-n'/
%
STOMACH
F'F.:O>m~AL1/3=·
::1::: . 4 .~{ .
'~.-
J.'a ••-;"-
rHODLE'1:<3;":";!
',,'{.',.,
STOMACH
DI-Ir:'::;TAL
1/3='
.•• ..'
.~ .~I ,,,.
ESOPHAGUS
(
-~ .,-
.....
.•.•..
!'<,/'f<'c!II/('/{/(/·.
--"..;
.........•
"~o
:tiO
••••
i"ig . .j - Fl'II/I.I'i[
...•...•.•....
.
[illlc
o!' [lic
c.l'IJl'llIIg/l.l'
I/('\V
'lJWI'C i.l' !1IIr1/1I!l'c[l'II(io/l
II/c{/.I'/ln'd
Ivi[1i IN
Fig/ll'e
AI{
n:/I/lr
5 - No
tI/'I//o/ls[m[cd
11'//('/1 1//('I/.\'III'('tI
IIli/1i /)() M
!'('/'(('clrl/(,[{/[c.
i/l [lic di.l'[{/llli.
COllllllcnt
Rccollstrucl
hypass
01'
hClligll
;1
i\
prohil'lll.
iOIl 01' Ihc csophagus
variei)'
\li' proposcd
has hccll
01' IlTl1lliqlll'S
and
111\l1'Ialily
ralcs
wilh
Il1c esoph:lgus
swallowillg
sl10uld
i\
/11;11IIlccralion,
.iuiccs,
lhe
procedure
round eighl
analol11ic:dly
:i1lcred
slll'll
sl11all so Ihal pullllonary
wirh durillg
as
lhe cOlllluil
occu rs
sllhclIl:1I1eollsly
I'lIllclion
wl1cll
placed
Ihc
nc\V
l'sophagus
1<), 20).
(14,
I'ound, alHI lhe replaccmenl
11 IS a
'I'he
slendel
ClllHluil
luhe
'I'hc lack 01' 1cl'lux in Ihese
hy scveral raclms:
alld
Renllx
M
wilh
lhe
calibel
palienls
CIll)
(15,
was lesled hy mcalls 01' a ladiollllciid
in I () palienls
I(),
rcplace-
wilh
(Ill)
Illall:rial
a 1'011
Illi
25
in acccplillg
(his
ralc. ln Ihis serics we
rale
reoperalion
01'
ov(;r
I'acililalcd
l1elllorrhage
lhe
01' Il1e
had a I'isllll:t
(I.X()%),
(ll.2(Yr,), alld
this lype 01' operalil1n
In
is helow
1lV.V". In Cllncillsillll
gaslric
duodenal
X44 cases I'olllld ill lhe
rale 01' 24.2%,
I ().5%.
rale 01'
inclucled
(I 1.1')%), sllhpl1rcnic
Ir we incillde
01'
heeause
complicaliolls
clllpycllla
Ihc morlalily
llloll1hs
porlion.
Illediaslinitis,
lIsillg
wilh
in lhe Ileck. Ir
Ihrec
(2.24fYr,),
lileralure
however,
growlh,
(2ll).
01' sllrgeons
OlheI'
(ll.4%),
Illorlalily
10 nlllrilion,
(O.5(l%),
cOl1lposile renllx
;IIHI Cl1uld 1101be
regard
in 5:1() procedures
(11=41).
ube nccrosis
world
wilh
or cOlllplicalions
is gl'l.:ally
pctic lIicer (5.Ú%).
IX).
cOlJlpared lhe
belwecn
01' 1l1eproxilllal
ahscess
may
Ilon-conslrictillg
lhis cl1ll1plicalioll
and did nol I'iml any dircrellce
period
pnelllllolhorax
t
lhe new angle 01' llis aI
(2
a
(;avriliu
ptaccd
wilh
1101 he
cases (1lV.!~,). Five 01' Ihese rcsolv(;d
wail
7J))lYo
Illllsl
,21). i\ndnsoll
<)
reluclallce
rcanaslolllosis
has heen
in children
lllhe
lhe
In adll\[s
and three reqllired
dital:llioll
lhe slol11ach; lhe 4 cm illllaabdominal
sm;dlcl
I'ellechllclale)
Iknlllllsl ra Ied.
(<)1)
is
revcrsed
C:111 hc
he expl:tilled
luhe
we
(I
ill
i\ndersllll
Il1rollgl1 a
has becn lhe I'islulous
ditalalioll
may Icach 10 ;IIlY
and
suhslcl'llally.
lhe .iunclioll
is 1101
a l11eal alld il should 1101hc visible,
gaslric tuhc l'ull'i1s Ihesc crilclia.
l'alicllls
cal a Illll'lllal
dicl, IH) lIiccr:Jlion
leveI.
1l11IS1he
The
I'reqllcnt
colonic
Illclhods,
p;lssage
will1
rasling
anlagonisl.
11Ib(; Icchniqlle
acceplahilily
The Illajor
are hlll'lled;
lubc.
!1I'ollgl1l
gaslric
(wo
palicnt
receplor
112
gaslric
Illenl ill children
so
palicnls
Iwo cascs 01' peplic ulccr
and
sllhSlilllle
havc sllllicicnl
mdelclllire
10 rcach
any Iev~l, 1l1lls1
cspccially
in cases inlenghl
which in lhe
I'ood
alld aiway
In Ihose
2) we recoll1llll:nd
Iws no! hcen reporled
Ihc
did cOll1plain 01' rcgurgilalion,
ill lhe diapl1ragm.
revcrscd
to pcplic
nol occm;
niglh.
reversed
openillg
cOllcluil to
Ihc \lI'gan
will
palienls
and lIS(; 01'
rl'llllndanl
in \lI'der
plc;lsanl;
I11l1sl rcsist
ai
lhe
l11ecl ccrl a in crilcria:
slenosis \li' hlceding
especially
(2ll) reporled
01' lhe csophagus
alld
cighl
evening
Surgcons
salisf;lct\ll'Y
shollld
he casy
IIscd 1'\lI' replacclllcnl
advocall'd
sever;d lechniques
10 avoid disasler (I Ú, 17, I X).
rcplacc
(14,/5).
Ilowever,
SYll1pll)Il1S (grad(;
cOl11plc1l: salisl'almy
in recollsI rucl ivc slll'gny
1IIlISI 11:lve l'al11iliarily
a cl1;dlellgillg
has hl'l'n
:IIHI 1ll1l1e lIas givcn
Ill\ll'hidily
illvolved
lesioll
a !'ter resecl ion or
lisll1la
cxperienced
4%
Ihere is a
in 2(>.7% and
hancls,
and I'istllla
we ht:lieve
rale
Il1e oj1eralioll
~
• XIMENES ET AL
ESOPHAGEALREPLACEMENT
S /\111J Tllomc
can lake ils place alllngside
especially
convenlillnal
11. Ileillllich
11.1. I{eversed
gaslric
lube
(IH;'!')
eSllphagllplasly ror railure 01' COiOIl, jejllllunl
alld
proslhelic illlerpositllllS. i\1l1l Surg 1()7\ IS2: 1)/1-1(,(1.
12. DUIlIl 0.1. B;lsic slalislics. i\ primeI' 10 lhe biollledical
sciellces, 21ld. Ed. .101111
Wiley & SllIlS, I nlldoll, Sidlley &
Torollto, I'J77; I()l-I 1(,.
lechniques,
when lhe defccl exlends 10 lhe high cervical
or pharyngeal
levels.
I acknowleJge lhe slalislical assislance ol' David Duarte
l.illl:l, MD,PhD, l'roll1 lhe lJlliversity 01'Brasilia.
I].
Beck
C,
Carrell
A.
Delllollstralioll
illuslraling
a Illelhlld
esoph;lgus.
II1 M J IlI()5;7:4(ll-4(J4.
or lúrlllalion
.li;IIlU I\. (iasll'llslolllie
ullll
I,Cilir
1'112;II:'U~n-YI().
].
4.
).
01' specimens
or a prethoraeic
oesopha-goplaslik.
N. Alllelhoracic
oellphagoplasty
lIalon
17. Maholley
ror
Kay
1::13.
Experimental
l.ollg-lcrlll
7(d()()-l()).
'I.
Ill.
NewYork,
rollow-up
lli'
childrell
wilh
'I'hmac Surg 1lJ77;2l:4()\)_LII ("
22, l,u(lsl:ll'illell
M. Nissell !lIlldllplicalioll
(;avriliu D. The replacelllelll 01' lhe esoph;lgus hy a
gastric (ube. 111.lalllieson (ie; r~d. Surgery llr lhe
C1ll1rchill & I.ivillgstolle,
esophag(lplasly
IlIS/l;Y:;:ll.\7-
C(llllll
;llId
g:lsll'il' luhe illleIjHlsilillll
!lll' e.s()pl1;lgl':i1 :llrl',si:1.
Surgery Il)l) I; 1/1: I] I-Il(,.
21. Orrillger M(j, Kirsh MM, Slt'all 11. New Irends ill
esophagcal replacelllclll
ror helligll
disease. 11.1111
SwellSOIl O,tvbggrllger
TV. Experilllenl;i1
esophagecloll1Y. Surgery 1')44; I ):ll)4_%].
C;avriliu 1), C;eorgescu I. I~sophagoplaslie direclacu
1ll:llerial gaslric,Rev Sliinl Med IlISI):ll-l(l.
hoph;lgus,
7(1)-7X().
Tolal
tllhe. Surg (iYlleL'll1 ()lJslei IlIK\ 1)(,:l71-J7/1.
2(). Alldcrsllll KD, NolJlell 11, Iklsey IIRII, Ralldolph .ICj.
011recollstruclive
illlralhoracic
esophagogaslric ;lIlasI<1I1111Sis
lúll()\villg
reseclioll 01'lhe eSllphagus. Surg (;Yllecol ()bstel 1'14l;
S.
CI).
righl l'(ll(lll Surgcry
IS. Xilllelles
M. 1':sol'h:lgeal repl;lcelllelll
lúr hl'lIigll
dise:lsc, (;ell Il)X(1;4(1:17l-1 X().
I\). O'COllllor TW. A hislorical review 01' revcrscd gaslric
CR. i\1l experinlelll:i1
llbservaliolls
EB, Sherlllanll
usillg illlralhm;lcic
l1/14.
slndy or lnbes Illade rrolll lhe grealer cnrvalure 01' lhe
slllll1ach . .I Thorac Cmlinvasc Surg 1941; 11:494-) I).
7.
Surg
7(n.
illlperllleable striclure 01' lhe esoph;lgus.i\1l1l Surg 1'>:l1;
I()(): 10))-1 ()ll I.
Carler IlN, AblJlllt ()i\,
Arch
I'e:lrsoll I.'(i, I.Jcslaurics .I, (;illshcrg RI, Iliehcrl ('/\.
McKlleally MF, lJr:sêhcl IIC,.Ir. . Esophagcal SlIIgery,
New Ymk NY, Churchill
& I.ivingslolle.
Jl)()); 7(,S-
I.olheissell
G.
Zur
Behadlullg
der
Speiserohellslriklurell. Zenlralbl Chir III U; 4(): I %ll_ll)7().
i\, ()wells
anastoll1osis.
I S, Skinller I)I~, Iklscy 1{l1R. Mallagenlelll 01'eS(lpl1agl';i1
dise;lses. W B S:llIlIdcrs, I'hil:llklpiJia,
Il)XS;2'i2-211') .
1(,. Fel I S{', {,aslric 11Ihcs:lü~vcrsl'd alld lIon reversl'd. 111
I)t:;cl1
llalpern .I. í'.ur Frage Vlll1 der SpeiserllplnellJllastLk
í'.elllralbl Chir 19I]; 4(): IX]4-i Xl9,
()chsller
Akyiallla
H. Esophageal
19n; I ()7:) 12-) 14.
14. Ilieberl Ci\, Bredenberg CL. Scleclioll :111l1
placelllenl
or cOllduits. 111I'earsoll FG, Deslauries .I, (jillshcrg
R.I,llieherl
CA, McKllcally
MF, lJrschcl 11(' .Ir.
Ncw
I(soplwgeal Surgcry. Churchill & l.ivillgslllllC,
York I (1()');(14()-(1.')(1.
Refel'ences
I.
SurU
1998;1:22-26
!Ill'
1'l'lIl1x
csophagitis. I.OIIg-lcrlll clillical and cndllscopic rcslllts
in IOl) 01' 127 cOllseclJlive palicnls. i\nll Surg 1')'13;
217: 3:2.9-]]7
Ili:')X;
Revision de ~rubo Ga~trico Invcrtido: Un n.clllplazo Esofagico Util
cn Patologia Benigna
Apesal' «ue eI tubo giístrico invertido de Ia cUl'VatunJ mayor que fue usado panl lesiones csofiígicas extensas pOI'casi 111I
siglo, Ias l'J'ecuentes .complicadones asosiadas ai procedimiento dejaron esta tccnica relegada y archivada por 111I largo
pedodo. Esle estudio revisa esla tccnica con su presentadtm adual. Fue rempla:wdo d esol:lgo, ron o sin Ia faringe,
usando d lubo g:lsldro inwrlido L'm HO paL'Íenles. I,os rasos ron raL'Ínoma fueron exdnidos. Sescnla y dnro paricntes
com eslcnosis clusfica, induyendo 44 paL'Íenles rcm pe.-!(lI'aL'Íim aguda y 15 L'on queimadnras de Ia faringc .v L'I
eslomago. EI seguimienlo fue realizado desde dos meses hasla 15 aílOs. Utilizando los rrilerios sngL',-idos por Visid, )'
Cols., 44 pacientes (5H.6%) no presentaron sintomas, veinle (26.6%) relirieron qnejas suaves y orho individuos
(10.6 %) IU'esentanm sintomas severos e l'J-ecuentes. EI procedimiento quirin'gico PUl'si mismo causú ] muerles (.t 7 (Yt, ).
(:on d Inbo g;hlrico invcrlido se pnede I'emplazal" L'Iesofago entero y Ia faringe ron scgnddad. H5.2% dc los padcnles
hilTon evalnados monslrando resnltados de buenos a exrL'lcnlL's y una morlalidad hospilalaria de 3.7%. Esla tt'rnica
«niriJrgira pnede tomar su Ingar aliado de otras técnicas ya eslabeleL'Ídas.
26