BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed ...BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.展开更多
目的总结采用改良Ivor-L ew is手术治疗胸中、下段食管癌的临床经验。方法1996年4月至2001年4月,576例食管癌患者经右胸前外侧切口和上腹部正中切口径路手术(改良Ivor-L ew is手术),切除胸段食管癌,用吻合器行食管胃右胸顶吻合。结果术...目的总结采用改良Ivor-L ew is手术治疗胸中、下段食管癌的临床经验。方法1996年4月至2001年4月,576例食管癌患者经右胸前外侧切口和上腹部正中切口径路手术(改良Ivor-L ew is手术),切除胸段食管癌,用吻合器行食管胃右胸顶吻合。结果术后发生乳糜胸1例,再次开胸手术治愈;术后胸腔内出血行开胸止血4例,发生吻合口瘘11例,均经保守治疗治愈。发生吻合口狭窄3例,术后病理检查食管残端癌残留1例,给予放射治疗。围手术期死亡2例,分别死于心肌梗死和心律失常。本组1、3、5年总的生存率分别为77.7%(446/574),57.8%(258/446),49.2%(127/258)。结论改良Ivor-L ew is手术是治疗胸中、下段食管癌的理想术式。展开更多
Background Minimally invasive Ivor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique. Thi...Background Minimally invasive Ivor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique. This study aimed to present our initial results of Ivor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique. Methods Six patients with esophageal cancer underwent minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis. The abdominal portion was operated on laparoscopically, and the thoracic portion was done using thoracoscopic techniques. A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position, the anvil head was then connected to circular stapler. The anastomosis was completed under direct thoracoscopic view. Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic Ivor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil. They were five male and one female patients, and had a mean age of 55 years （range, 38-69 years）. The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy. The passage of the anvil head was technically easy and successful in all six cases. The mean overall operative time was （260_＋42） minutes （range, 220-300 minutes）, and the mean estimated blood loss was （520_＋160） ml （range, 130-800 ml）. Patients resumed a liquid oral diet on postoperative day seven. The median length of hospital stay was 17 days （range, 9-25 days）. The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient. Tumors were staged as T2NoMo in three cases, T2N1M0 in one case, and T3NoM0 in two cases. During the mean follow-up of 2.5 months （range, 2-4 months）, there were no intraoperative technical failure of the anastomosis or major postoperative complications such as leak or stricture. Conclusions The initial results of this small series suggest that minimally invasive Ivor Lewis esophagectomy for malignant esophageal tumor is technically feasible. However, further multi-center prospective studies and thorough evaluation are needed to evaluate the long-term results.展开更多
Surgical advancements in developing countries involve many challenges pertaining to health care coverage and management of limited resources.Here we report the first cases of robot assisted minimally invasive esophage...Surgical advancements in developing countries involve many challenges pertaining to health care coverage and management of limited resources.Here we report the first cases of robot assisted minimally invasive esophageal surgery performed in Colombia to discuss the development of such surgery in our country.展开更多
文摘BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
文摘目的总结采用改良Ivor-L ew is手术治疗胸中、下段食管癌的临床经验。方法1996年4月至2001年4月,576例食管癌患者经右胸前外侧切口和上腹部正中切口径路手术(改良Ivor-L ew is手术),切除胸段食管癌,用吻合器行食管胃右胸顶吻合。结果术后发生乳糜胸1例,再次开胸手术治愈;术后胸腔内出血行开胸止血4例,发生吻合口瘘11例,均经保守治疗治愈。发生吻合口狭窄3例,术后病理检查食管残端癌残留1例,给予放射治疗。围手术期死亡2例,分别死于心肌梗死和心律失常。本组1、3、5年总的生存率分别为77.7%(446/574),57.8%(258/446),49.2%(127/258)。结论改良Ivor-L ew is手术是治疗胸中、下段食管癌的理想术式。
文摘Background Minimally invasive Ivor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique. This study aimed to present our initial results of Ivor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique. Methods Six patients with esophageal cancer underwent minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis. The abdominal portion was operated on laparoscopically, and the thoracic portion was done using thoracoscopic techniques. A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position, the anvil head was then connected to circular stapler. The anastomosis was completed under direct thoracoscopic view. Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic Ivor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil. They were five male and one female patients, and had a mean age of 55 years （range, 38-69 years）. The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy. The passage of the anvil head was technically easy and successful in all six cases. The mean overall operative time was （260_＋42） minutes （range, 220-300 minutes）, and the mean estimated blood loss was （520_＋160） ml （range, 130-800 ml）. Patients resumed a liquid oral diet on postoperative day seven. The median length of hospital stay was 17 days （range, 9-25 days）. The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient. Tumors were staged as T2NoMo in three cases, T2N1M0 in one case, and T3NoM0 in two cases. During the mean follow-up of 2.5 months （range, 2-4 months）, there were no intraoperative technical failure of the anastomosis or major postoperative complications such as leak or stricture. Conclusions The initial results of this small series suggest that minimally invasive Ivor Lewis esophagectomy for malignant esophageal tumor is technically feasible. However, further multi-center prospective studies and thorough evaluation are needed to evaluate the long-term results.
文摘Surgical advancements in developing countries involve many challenges pertaining to health care coverage and management of limited resources.Here we report the first cases of robot assisted minimally invasive esophageal surgery performed in Colombia to discuss the development of such surgery in our country.
