Gastric tube pull-up after esophagectomy for cancer
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spcir.com/index.php/spcir/article/view/309 |
Resumo: | Introduction: Anastomotic complications are responsible for significant morbidity after oesophagectomy for cancer. Cervical oesophagogastrostomy is associated with high incidence of anastomotic leaks (0 – 18%) and stenosis (1- 43%). The aim of this study was to address the reliability of our method of preparation of the gastric tube, the pull-up of the gastric conduit and the esophagogastrostomy, based on a consecutive series of esophagetomies for cancer. Material and Methods: Retrospective analysis of the last 50 consecutive patients, with oesophageal carcinoma, 7 female and 43 males, median of age 63 [46-85] years. Oesophagocoloplasties were excluded from the group. A gastric tube was pulled-up to the thorax (n=3) or the neck (n=47). Gentle manipulation of the stomach in all the steps of its mobilization, preservation of the gastric vascularization of the tube (details for preserving the right and left gastric vascular arcades and networks were focused), the technique to carry out the gastric pull-up and the hand-sewn end-to-lateral anastomosis to the posterior face of the tube were key technique details presented. Homeostatic monitoring was guaranteed. Clinical, endoscopic and radiologic control of the anastomosis was done. Endoscopic control of bleeding and stenosis was achieved on demanding cases.Results: 2 anastomotic leaks and 1 detected only on radiologic study. No gastric tube necrosis. 1 haemorrhage endoscopic controlled. 11 cases of post-operative stenosis required one ore more dilatation sessions through the first year. Hospital stays, median – 19 [9-64] days. Mortality: 8 weeks – 8%; in hospital – 14%. Survival median – 17 [3 – 75] months.Conclusions: A reliable preparation of the gastric tube for pulling up is founded on key technique points. Strict adherence to a meticulous preservation of the gastric tube vascularization is mandatory for minimizing complications. Control of the homeostasis during the operative procedure and in the post-operative period was a significant issue in our experience. Early diagnosis and fixing of complication is crucial for getting good results.Keywords: gastric tube, gastric tube pull-up, cervical oesophagogastrostomy |
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Gastric tube pull-up after esophagectomy for cancerTransposição cervical de tubo gástrico na reconstrução digestiva após esofagectomia por cancro do esófago – detalhes técnicosIntroduction: Anastomotic complications are responsible for significant morbidity after oesophagectomy for cancer. Cervical oesophagogastrostomy is associated with high incidence of anastomotic leaks (0 – 18%) and stenosis (1- 43%). The aim of this study was to address the reliability of our method of preparation of the gastric tube, the pull-up of the gastric conduit and the esophagogastrostomy, based on a consecutive series of esophagetomies for cancer. Material and Methods: Retrospective analysis of the last 50 consecutive patients, with oesophageal carcinoma, 7 female and 43 males, median of age 63 [46-85] years. Oesophagocoloplasties were excluded from the group. A gastric tube was pulled-up to the thorax (n=3) or the neck (n=47). Gentle manipulation of the stomach in all the steps of its mobilization, preservation of the gastric vascularization of the tube (details for preserving the right and left gastric vascular arcades and networks were focused), the technique to carry out the gastric pull-up and the hand-sewn end-to-lateral anastomosis to the posterior face of the tube were key technique details presented. Homeostatic monitoring was guaranteed. Clinical, endoscopic and radiologic control of the anastomosis was done. Endoscopic control of bleeding and stenosis was achieved on demanding cases.Results: 2 anastomotic leaks and 1 detected only on radiologic study. No gastric tube necrosis. 1 haemorrhage endoscopic controlled. 11 cases of post-operative stenosis required one ore more dilatation sessions through the first year. Hospital stays, median – 19 [9-64] days. Mortality: 8 weeks – 8%; in hospital – 14%. Survival median – 17 [3 – 75] months.Conclusions: A reliable preparation of the gastric tube for pulling up is founded on key technique points. Strict adherence to a meticulous preservation of the gastric tube vascularization is mandatory for minimizing complications. Control of the homeostasis during the operative procedure and in the post-operative period was a significant issue in our experience. Early diagnosis and fixing of complication is crucial for getting good results.Keywords: gastric tube, gastric tube pull-up, cervical oesophagogastrostomy Introdução: A anastomose esofagogástrica cervical está associada a taxa elevada de deiscências (0-18%) e estenoses ( até 43%). O objectivo deste trabalho é analisar uma série consecutiva de doentes submetidos a esofagectomia, em que o tubo gástrico foi sistematicamente elaborado para minimizar estas complicações. Material e Métodos: Estudo retrospectivo, incluindo os últimos 50 doentes consecutivos, com Carcinoma do esófago, 7 F e 43 M, idade média 63 [46-85] anos. Foram excluídos deste estudo os doentes sem cancro esofágico e as esofagocoloplastias. Na construção do tubo gástrico (n=50) e na sua mobilização para o tórax (n=3) ou para o pescoço (n=47) foi tido em atenção: manipulação mínima do estômago, preservação cuidada da vascularização, manobra de Kocher para que o piloro seja mobilizável até ao hiato, piloromiotomia, anastomose esofagogástrica término-lateral. A estabilidade hemodinâmica e ventilatória, intra e pós-operatórias, foram cuidadosamente asseguradas por monitorização contínua. Avaliação clínica e radiológica da continência e permeabilidade das anastomoses. Dilatação endoscópica das estenoses. Resultados: 2 fístulas cervicais (clínicas) e 1 radiológica. Não se verificou nenhuma necrose da plastia. Os 11 doentes com estenose foram submetidos a dilatações endoscópicas. O tubo gástrico com operação de drenagem pilórica comportou-se como um bom método de assegurar a alimentação dos doentes esofagectomizados sem ter sido necessário nenhuma substituição do conduto. Conclusão: Os detalhes técnicos da construção da plastia gástrica e a estabilidade peri-operatória são factores determinantes dos resultados conseguidos com esta técnica. Palavras-chave: Tubo gástrico, transposição cervical gástrica, anastomose esofagogástrica cervical. Sociedade Portuguesa de Cirurgia2014-01-13info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spcir.com/index.php/spcir/article/view/309Revista Portuguesa de Cirurgia; No 25 (2013): Junho 2013 - II Série; 9-21Revista Portuguesa de Cirurgia; No 25 (2013): Junho 2013 - II Série; 9-212183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spcir.com/index.php/spcir/article/view/309https://revista.spcir.com/index.php/spcir/article/view/309/300Copyright (c) 2016 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessCosta, PauloEsteves, RuiLages, PatríciaFerreira, Filipa2023-09-07T16:46:05ZPortal AgregadorONG |
dc.title.none.fl_str_mv |
Gastric tube pull-up after esophagectomy for cancer Transposição cervical de tubo gástrico na reconstrução digestiva após esofagectomia por cancro do esófago – detalhes técnicos |
title |
Gastric tube pull-up after esophagectomy for cancer |
spellingShingle |
Gastric tube pull-up after esophagectomy for cancer Costa, Paulo |
title_short |
Gastric tube pull-up after esophagectomy for cancer |
title_full |
Gastric tube pull-up after esophagectomy for cancer |
title_fullStr |
Gastric tube pull-up after esophagectomy for cancer |
title_full_unstemmed |
Gastric tube pull-up after esophagectomy for cancer |
title_sort |
Gastric tube pull-up after esophagectomy for cancer |
author |
Costa, Paulo |
author_facet |
Costa, Paulo Esteves, Rui Lages, Patrícia Ferreira, Filipa |
author_role |
author |
author2 |
Esteves, Rui Lages, Patrícia Ferreira, Filipa |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Costa, Paulo Esteves, Rui Lages, Patrícia Ferreira, Filipa |
description |
Introduction: Anastomotic complications are responsible for significant morbidity after oesophagectomy for cancer. Cervical oesophagogastrostomy is associated with high incidence of anastomotic leaks (0 – 18%) and stenosis (1- 43%). The aim of this study was to address the reliability of our method of preparation of the gastric tube, the pull-up of the gastric conduit and the esophagogastrostomy, based on a consecutive series of esophagetomies for cancer. Material and Methods: Retrospective analysis of the last 50 consecutive patients, with oesophageal carcinoma, 7 female and 43 males, median of age 63 [46-85] years. Oesophagocoloplasties were excluded from the group. A gastric tube was pulled-up to the thorax (n=3) or the neck (n=47). Gentle manipulation of the stomach in all the steps of its mobilization, preservation of the gastric vascularization of the tube (details for preserving the right and left gastric vascular arcades and networks were focused), the technique to carry out the gastric pull-up and the hand-sewn end-to-lateral anastomosis to the posterior face of the tube were key technique details presented. Homeostatic monitoring was guaranteed. Clinical, endoscopic and radiologic control of the anastomosis was done. Endoscopic control of bleeding and stenosis was achieved on demanding cases.Results: 2 anastomotic leaks and 1 detected only on radiologic study. No gastric tube necrosis. 1 haemorrhage endoscopic controlled. 11 cases of post-operative stenosis required one ore more dilatation sessions through the first year. Hospital stays, median – 19 [9-64] days. Mortality: 8 weeks – 8%; in hospital – 14%. Survival median – 17 [3 – 75] months.Conclusions: A reliable preparation of the gastric tube for pulling up is founded on key technique points. Strict adherence to a meticulous preservation of the gastric tube vascularization is mandatory for minimizing complications. Control of the homeostasis during the operative procedure and in the post-operative period was a significant issue in our experience. Early diagnosis and fixing of complication is crucial for getting good results.Keywords: gastric tube, gastric tube pull-up, cervical oesophagogastrostomy |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-01-13 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/309 |
url |
https://revista.spcir.com/index.php/spcir/article/view/309 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/309 https://revista.spcir.com/index.php/spcir/article/view/309/300 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No 25 (2013): Junho 2013 - II Série; 9-21 Revista Portuguesa de Cirurgia; No 25 (2013): Junho 2013 - II Série; 9-21 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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