Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.
Abdominal Wall ; surgery ; Aged ; Esophageal Stenosis ; etiology ; Female ; Fundoplication ; adverse effects ; methods ; Heartburn ; etiology ; Hernia, Hiatal ; diagnosis ; surgery ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects ; Postoperative Complications

BACKGROUND/AIMS: Endoscopic resection (ER) of superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ER for SEN to determine its feasibility and effectiveness. METHODS: Subjects who underwent ER for SEN at Asan Medical Center between December 1996 and December 2010 were eligible. The clinical features of patients and tumors, histopathological characteristics, adverse events, ER results and survival were investigated. RESULTS: A total of 129 patients underwent ER for 147 SENs. En bloc resection (EnR) was performed in 118 lesions (80.3%). Complete resection (CR) was accomplished in 128 lesions (86.5%), and curative resection (CuR) was performed in 118 lesions (79.7%). The EnR, CR, and CuR rates were significantly greater in the endoscopic submucosal dissection group when compared to those in the endoscopic resection group. Adverse events occurred in 22 patients (17.1%), including bleeding (n=2, 1.6%), perforation (n=12, 9.3%), and stricture (n=8, 6.2%). Local tumor recurrence occurred in 2.0% of patients during a median follow-up of 34.8 months. The 5-year overall and disease-specific survival rates were 94.0% and 97.5%, respectively. CONCLUSIONS: ER is a feasible and effective method for the treatment of SEN as indicated by favorable clinical outcomes.
Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*adverse effects/methods ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation/epidemiology/etiology ; Esophageal Stenosis/epidemiology/etiology ; Esophagoscopy/*adverse effects/methods ; Female ; Gastric Mucosa/surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Hemorrhage/epidemiology/etiology ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of endoscopic balloon dilatation, stenting and surgery in treating corrosive esophageal stricture of children.

METHODWe retrospectively analyzed the management of 31 children who were treated with endoscopic balloon dilatation, stenting or gastric tube esophagoplasty because of corrosive esophageal stricture between August 2005 and December 2012. Dysphagia was graded into 4 grades according to Stooler grading methods. The efficacy was divided into 3 grades which were very effective, effective and ineffective according to the improvement of dysphagia.

RESULTAmong 31 children with corrosive esophageal stricture, in 22 children the problem was caused by alkali, in 9 by acid; 23 children had long-segment stricture and 8 had short-segment stricture. The number (rates) of cases in whom the endoscopic balloon dilatation was very effective, effective, and ineffective were 12 (38.7%) , 7 (22.6%) , 12 (38.7%) , respectively. The number of cases in whom stenting was effective or ineffective was 1 and 3, respectively. The gastric tube esophagoplasty was very effective and effective in 8 and 2 cases, respectively. Total rates of very effective, effective, and ineffective of 3 treatments were 64.5%, 29%, 6.5% respectively. The efficacy of endoscopic balloon dilatation was better in short-segment stricture and bigger caliber stricture, the efficacy was not so good for other types of strictures. The efficacy of balloon dilatation was not related with the nature of substances (either alkaline or acidic). Compared with very effective group, the ineffective group with longer course of disease before dilatation (t = -2.091, P = 0.048) , smaller stricture calibre (t = 2.855, P = 0.009) , longer stricture segment (t = -3.405, P = 0.003) and longer dilatation time (t = -2.103, P = 0.047) , had statistical significance.

CONCLUSIONEndoscopic balloon dilatation was the preferred treatment for corrosive esophageal stricture of children. The efficacy was better in shorter course of disease, short-segment stricture and bigger caliber stricture, for other situations the efficacy was not so good. The efficacy of balloon dilatation was not related with the nature of substances.Stent or surgery can be considered if efficacy of balloon dilatation was not so good.Gastric tube esophagoplasty is an effective treatment for complicated corrosive esophageal stricture.

Burns, Chemical ; complications ; therapy ; Child ; Child, Preschool ; Deglutition Disorders ; etiology ; surgery ; therapy ; Dilatation ; instrumentation ; methods ; Esophageal Stenosis ; etiology ; surgery ; therapy ; Female ; Gastroscopy ; Humans ; Infant ; Male ; Retrospective Studies ; Stents ; Treatment Outcome

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option.
Administration, Topical ; Adrenal Cortex Hormones/*therapeutic use ; Adult ; Child ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/diagnosis/*therapy ; Esophageal Stenosis/etiology/*surgery ; Esophagoscopy ; Esophagus/*pathology ; *Food Habits ; Gastroesophageal Reflux/diagnosis ; Humans

OBJECTIVETo identify the risk factors of benign cervical anastomotic strictures after esophagectomy.

METHODSClinical data of 946 esophageal cancer patients undergoing esophagectomy with cervical anastomosis between 2003 and 2012 were analyzed retrospectively. Benign stricture was defined as dysphagia for which endoscopic dilation of the anastomosis was needed. Histologically proven malignant stricture was not regarded as benign stricture. χ(2) test and logistic regression model were used for univariate and multivariate analysis respectively.

RESULTSA total of 146 patients(16.5%) developed benign stricture during follow-up. Univariate analysis showed that the patients with cardiovascular disease (P=0.001), diabetes mellitus(P=0.041), gastric tube reconstruction(P=0.050), end-to-end anastomosis (P=0.013), or postoperative anastomotic leakage(P=0.008) had higher stricture rate. Multivariate analysis revealed that cardiovascular disease(P=0.004), gastric tube reconstruction (P=0.026), end-to-end anastomosis(P=0.043), and postoperative anastomotic leakage(P=0.001) were independently predictive factors for development of benign stricture.

CONCLUSIONSThe benign cervical stricture rate after esophagetomy with cervical gastric anastomosis is quite high. In order to prevent benign stricture formation, end-to-end anastomosis should be avoid. Blood pressure should be controlled for those with cardiovascular disease. Endoscopic dilation in an earlier stage postoperatively should be considered for those who develop anastomotic leakage.

Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; Constriction, Pathologic ; etiology ; Deglutition Disorders ; etiology ; Esophageal Neoplasms ; complications ; surgery ; Esophageal Stenosis ; etiology ; Esophagectomy ; adverse effects ; Follow-Up Studies ; Humans ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; adverse effects ; Retrospective Studies ; Risk Factors

OBJECTIVECongenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. This study was conducted to understand the clinical features of TBR.

METHODThe data of the four cases with TBR admitted to our hospital and 76 patients identified from the literature were reviewed. The clinical manifestation, X-ray, endoscopy, biopsy and treatment were studied retrospectively.

RESULTOf the total of 80 cases, 45 were male, 33 were female, and for 2 cases the gender was unknown. Symptoms of dysphagia and regurgitation developed at the age of 1-day to 12-month. Definitive treatment was carried out at the age of 1-month to 16-year. Twenty-seven patients had associated anomalies with esophageal atresia being the most prevalent. X-ray esophagography showed segmental stenosis at the distal third of the esophagus in all patients except three. An abrupt narrow segment at the lower esophagus with marked proximal dilatation was found in 32 cases. Esophagography of 12 cases showed distal esophageal stenosis with tapered narrowing. Esophagography of 20 cases showed flask-shaped shadow of distal esophageal stenosis and one patient showed linear projection of barium at the level of stenosis. Endoscopy found almost complete obstruction of the lower esophageal lumen without signs of the esophagitis or reflux. Esophagoscopic dilatation of the stenosis was attempted in 24 cases, but was ineffective, and 3 patients suffered esophageal perforation. Seventy-nine patients underwent resection of the stenotic segment. Histologic examination of the resected specimen showed cartilage, mucus glands, resembling bronchal tissue. Post-operative complication included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux.

CONCLUSIONTBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food. Esophagography and esophagoscopy are the essential means for diagnosis. TBR should be different from achalasia and should be diagnosed by biopsy. Operation is the only choice of treatment.

Anastomosis, Surgical ; Barium Sulfate ; Biopsy ; Child, Preschool ; Choristoma ; complications ; Dilatation ; Esophageal Atresia ; complications ; Esophageal Perforation ; etiology ; Esophageal Stenosis ; congenital ; diagnosis ; pathology ; surgery ; Esophagoscopy ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tracheoesophageal Fistula ; etiology

OBJECTIVETo study the clinical value of gastric tube esophagoplasty for complicated corrosive stricture of the esophagus in children.

METHODSA retrospective analysis was performed to study 7 patients with complicated corrosive stricture of the esophagus who were treated with gastric tube esophagoplasty via retrosternal route between March 2010 and October 2011.

RESULTSThree patients had a stricture longer than 2.5 cm, and 4 patients had more than one stricture. All the operations went well. The average time for mechanical ventilation postoperatively was 6 hours. No patients showed insufficient ventilation after withdraw of ventilator. There was 1 patient developed anastomotic leak which was healed a week later. One patient had anastomotic leak with pyloric obstruction, and the leak was healed 3 weeks after intraoperative placement of duodenal feeding tube and pyloric obstruction became patent 4 weeks later. There were 2 patients developed anastomotic stricture and they resumed normal diet after balloon dilatation. The average follow-up duration was 10.5 months. The quality of life was improved and no other complications were found.

CONCLUSIONGastric tube esophagoplasty is a effective alternative for complicated corrosive stricture of the esophagus and the short-term outcomes are favorable.

Burns, Chemical ; complications ; Child ; Child, Preschool ; Cicatrix ; complications ; Esophageal Stenosis ; etiology ; surgery ; Esophagoplasty ; methods ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stomach ; surgery ; Treatment Outcome

OBJECTIVE: To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy, and to reduce the incidence of cervical esophagogastric anastomotic stricture. METHODS: A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010. Among them, 96 cases were treated with traditional full layer interrupted varus suture (varus group) and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture (laminated group). Esophageal angiography was performed in 1 week, 1 month, and 3 months after the operation. The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively. The area of anastomatic stoma was calculated. The degree of stenosis was assessed according to the patients' dysphagia symptom. RESULTS: There was no operative deaths, no serious pulmonary complications and chylothorax, no sever esophageal reflux in all patients. The ratio of cervical esophagogastric anastomotic leakage was 2.1% (2/96) in the varus group. No anastomotic leakage in the laminated group. Compared with the varus group, the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points (P<0.01). The incidence of obstruction in the laminated group was decreased significantly (P<0.01) in 1 month or in 3 months after operation compared with the varus group. CONCLUSION Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.
Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; adverse effects ; methods ; Biocompatible Materials ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophageal Stenosis ; etiology ; prevention & control ; Esophagectomy ; methods ; Female ; Gastrostomy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Suture Techniques

OBJECTIVETo study the validity of transplanting transverse colon to replace esophagus in treating cicatricial stricture resulting from severe esophageal chemical burns in children.

METHODSA retrospective study was carried out on the clinical data of 46 patients with severe chemical esophageal burns who were treated from November 1972 to September 2008. The transverse colon with the ascending branch of the left colic artery was brought through a retrosternal tunnel to replace strictured esophagus. Thirty-two patients underwent colon-esophageal anastomosis and 14 patients underwent colon-pharyngeal anastomosis.

RESULTSAll patients survived after surgery, but complications occurred in 7 cases, including leakage of anastomosis in cervical region in 4 cases, stenosis of anastomosis in 2 cases, and dyspnea in 1 case, and they were cured after due treatment. Follow-up study (1 - 26 years) in 39 patients revealed that there was no difference in growth, development and diet between the patients and the normal children of the same age.

CONCLUSIONSEsophageal reconstruction with transverse colon together with the ascending branch of the left colic artery through a retrosternal tunnel is a valuable method for treating cicatricial stricture of the esophagus secondary to severe chemical burns of the esophagus in children.

Burns, Chemical ; complications ; surgery ; Child ; Child, Preschool ; Cicatrix ; complications ; etiology ; Colon, Transverse ; transplantation ; Esophageal Stenosis ; etiology ; surgery ; Esophagus ; surgery ; Female ; Humans ; Infant ; Male ; Postoperative Complications ; surgery ; Retrospective Studies

OBJECTIVETo analyze retrospectively the roles of different factors, especially the factors in the anastomotic cicatricial, stenosis after esophagectomy.

METHODSThe clinical data of 1111 patients, undergone esophagectomy with immediate reconstruction for cancer in the Sun Yat-sen Cancer Center from December 1997 to December 2003, were analyzed retrospectively. Up to 19 factors were evaluated by univariate and multivariate Logistic regression analysis with SPSS 11.5 for windows. Spearman rank correlation was used to evaluate the factors that were statistically significant in Logistic regression analysis.

RESULTSThe overall incidence of anastomotic cicatricial stenosis was 6.84%. By using univariate Logistic regression, sustained-hypoxemia (P=0.003), chest complications (P=0.000), anastomotic leakage (P=0.000), a history of diabetes (P=0.019), a history of chronic obstructive pulmonary disease (P=0.046) and cardiovascular complications (P=0.015) came out to be significantly related to anastomotic stenosis. Multivariate Logistic regression showed that sustained-hypoxemia (P=0.044), chest complications (P=0.009), anastomotic leakage (P=0.001) and a history of diabetes (P=0.036) were statistically significant. Spearman rank correlation estimation revealed that sustained-hypoxemia was positively correlated with chest complications (r=0.105) and anastomotic leakage,(r=0.106), and chest complications were positively correlated with anastomotic leakage (r=0.228).

CONCLUSIONSustained-hypoxemia is one of the significant factors for anastomotic cicatricial stenosis after esophagectomy.

Aged ; Anastomosis, Surgical ; Esophageal Stenosis ; etiology ; Esophagectomy ; adverse effects ; Esophagus ; surgery ; Female ; Humans ; Hypoxia ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Risk Factors