A Useful Esophageal Replacement for Benign Disease
Transcrição
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
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