Esophagoplasty ; methods ; Esophagus ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Stomach ; anatomy & histology ; surgery

BACKGROUND: It has been reported that there are four zones of distinct venous patterns around the gastroesophageal junction (GEJ); i.e. truncal, perforating, palisade (PZ) and gastric zones. Using the distal end of PZ as a marker for GEJ, this study was done to assess the length and patterns of PZ in Koreans, and to assess the prevalence of endoscopic Barrett's esophagus (E-BE) and hiatal hernia (E-HH). METHODS: 847 consecutive patients undergoing diagnostic endoscopy were included. During endoscopy, PZ, squamocolumnar junction (SCJ) and pinchcock action (PCA) were identified. Patterns were classified according to the relationships of the distal end of PZ with SCJ and PCA; A: all three at the same level, B: SCJ proximal to the other two which are at the same level, C: PCA distal to the other two which are at the same level, D: SCJ proximal to the distal end of PZ which is proximal to PCA. Cases with patterns B and D were thought to have E-BE, and those with patterns C and D to have E-HH. RESULTS: Patterns A, B, C and D were 79.2%, 12.1%, 3.8% and 4.9%, respectively. Length of PZ was 3.0+/-0.1 cm. E-BE and E-HH were found in 17.0% and 8.7%, respectively. Both E-BE and E-HH were more frequently found in males and in cases with reflux esophagitis. CONCLUSION: E-BE and E-HH are not so infrequent in Koreans as previously thought, if we use the distal end of PZ as an endoscopic marker of GEJ.
Barrett Esophagus/epidemiology ; Capillaries/anatomy & histology ; Esophagogastric Junction/*anatomy & histology/*blood supply ; *Esophagoscopy ; Esophagus/*anatomy & histology/*blood supply ; Female ; Hernia, Hiatal/epidemiology ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Regional Blood Flow

OBJECTIVETo explore the anatomic features of mesoesophagus in combined thoracoscopic and laparoscopic esophagectomy with three-fields lymphadenectomy.

METHODSClinical data of 67 patients undergoing thoracoscopic and laparoscopic esophagectomy with three-fields lymphadenectomy from July 2011 to September 2012 were analyzed retrospectively. All the patients underwent three-fields lymphadenectomy. Proper surgical planes were selected according to anatomy of mesoesophagus. Thoracoscopic surgical space was bounded on azygotic vein and divided into upper and low esophageal triangle. Pancreas was the key anatomical mark for laparoscopic gastric dissection, and peripancreatic space was the natural laparoscopic surgical plane. Prevertebral fascia was bottom surface of neck dissection and carotid sheath was the boundary of two sides.

RESULTSThe median operative time was 251.6 min (range, 220 to 320 min). The median operative blood loss was 105.6 ml (range, 40 to 320 ml). The median number of lymph nodes dissected was 29.1 (range, 13 to 46, totally 1949). There was no perioperative death. Sixty-six patients were followed up with a mean follow-up time of 8.2 months (range, 2 to 14 months). Postoperative complications included reflux esophagitis in 10 and anastomotic stenosis in 3 cases.

CONCLUSIONIt is safe and more radical for minimally invasive esophagectomy that overall concept of minimally invasive anatomy of mesoesophagus is applied to identify the anatomic plane and landmark during operation.

Aged ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Esophagus ; anatomy & histology ; pathology ; Female ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies

Corticotrophin-releasing factor (CRF) plays a major role in coordinating stress responses. We aimed to test whether blocking endogenous CRF activity can prevent the stress-induced dilation of intercellular spaces in esophageal mucosa. Eighteen adult male rats were divided into 3 groups: 1) a non-stressed group (the non-stressed group), 2) a saline-pretreated stressed group (the stressed group), 3) and an astressin-pretreated stressed group (the astressin group). Immediately after completing the experiments according to the protocol, distal esophageal segments were obtained. Intercellular space diameters of esophageal mucosa were measured by transmission electron microscopy. Blood was sampled for the measurement of plasma cortisol levels. Mucosal intercellular spaces were significantly greater in the stressed group than in the non-stressed group. Mucosal intercellular spaces of the astressin group were significantly smaller than those of the stressed group. Plasma cortisol levels in the stressed group were significantly higher than in the non-stressed group. Pretreatment with astressin tended to decrease plasma cortisol levels. Acute stress in rats enlarges esophageal intercellular spaces, and this stress-induced alteration appears to be mediated by CRF. Our results suggest that CRF may play a role in the pathophysiology of reflux-induced symptoms or mucosal damage.
Animals ; Corticotropin-Releasing Hormone/*antagonists & inhibitors/metabolism/pharmacology ; Esophagus/anatomy & histology/*drug effects ; Extracellular Space/*drug effects ; Hydrocortisone/blood ; Male ; Mucous Membrane/anatomy & histology/*drug effects ; Neuroprotective Agents/pharmacology ; Peptide Fragments/*pharmacology ; Rats ; Rats, Wistar ; *Stress, Psychological/blood/physiopathology

OBJECTIVE: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series. METHOD: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed. RESULT: Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively. CONCLUSION Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
Adult ; Aged ; Esophagoplasty ; methods ; Esophagus ; surgery ; Graft Survival ; Humans ; Hypopharynx ; surgery ; Male ; Middle Aged ; Neck ; blood supply ; Necrosis ; Retrospective Studies ; Surgical Flaps ; pathology ; Transplant Donor Site ; anatomy & histology ; Treatment Outcome