1.Observation on the long-term complications after esophageal replacement with colon.
Bang-chang CHENG ; Jun XIA ; Xi-ping LIU ; Zhi-fu MAO ; Zhi-yong ZENG ; Jie HUANG ; Yong-guang XIAO ; Tu-sheng WANG ; Hao HU ; Xiao-jian WU
Chinese Journal of Surgery 2007;45(2):118-120
OBJECTIVETo study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease.
METHODSTo review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form.
RESULTSEight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously.
CONCLUSIONSThe iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.
Adult ; Colon ; surgery ; Esophageal Diseases ; surgery ; Esophagoplasty ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; surgery ; Reoperation ; Retrospective Studies
2.A Case of More Abundant and Dysplastic Adenomas in the Interposed Colon than in the Native Colon.
Hye Jin HWANG ; Kyung Ho SONG ; Young Hoon YOUN ; Ji Eun KWON ; Hoguen KIM ; Jae Bock CHUNG ; Yong Chan LEE
Yonsei Medical Journal 2007;48(6):1075-1078
We report a 60-year-old woman with intramucosal adenocarcinoma arising in the interposed colon, 40 years after the esophageal reconstruction for lye induced esophageal stricture. Although synchronous adenomas were also found in the native colon where the graft was taken, the number of adenomas was greater in the interposed colon and more dysplastic, even progressed to adenocarcinoma, than that of the native colon. The microsatellite instability-testing performed in the intramucosal carcinoma from interposed colon showed absence of microsatellite instability. Changing of location and functional deman]d of colonic segment, and the exposure to different intraluminal contents might have facilitated the adenoma- carcinoma transformation in the interposed colon.
Adenocarcinoma/pathology
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Adenoma/etiology/*pathology
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Colon/*pathology
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Colonic Neoplasms/etiology/*pathology
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Disease Progression
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Esophagoplasty/adverse effects/methods
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Female
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Humans
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Middle Aged
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Postoperative Complications/etiology/pathology
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Time Factors
3.Application of gastroepiploic tunnel esophagogastrostomy in minimally invasive esophagectomy.
Lin ZHOU ; Peng GE ; Jiakuan CHEN ; Jian WANG ; Ming WANG ; Xiaofei LI ; Tao JIANG
Chinese Journal of Gastrointestinal Surgery 2016;19(9):1021-1024
OBJECTIVETo explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.
METHODSClinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.
RESULTSAll the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).
CONCLUSIONThe gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.
Anastomosis, Surgical ; adverse effects ; methods ; Anastomotic Leak ; epidemiology ; prevention & control ; Comparative Effectiveness Research ; Constriction, Pathologic ; epidemiology ; prevention & control ; Esophageal Neoplasms ; complications ; surgery ; Esophagectomy ; adverse effects ; methods ; Esophagoplasty ; adverse effects ; methods ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Neck ; surgery ; Omentum ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Surgical Stapling ; adverse effects ; methods