Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report

Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.

Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up:A case report

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.

Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.

对Pull-up效应革的认识

笔者根据近几年外国化工公司来沪交流的情况,以及笔者从事新产品项目研究的实践经验,重点阐述Pull—up效应革的特征、特点、变色机理、Pull—up油的特性、坯革、涂层的剖析、产品企业标准的制定。

Graft dilatation and Barrett’s esophagus in adults after gastric pullup and jejunal interposition for long-gap esophageal atresia

BACKGROUND Esophageal replacement(ER)with gastric pull-up(GPU)or jejunal interposition(JI)used to be the standard treatment for long-gap esophageal atresia(LGEA).Changes of the ER grafts on a macro-and microscopic level however,are unknown.AIM To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.METHODS A cohort study was conducted including all LGEA patients≥16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands.Patients underwent clinical assessment,contrast study and endoscopy with biopsy.Data was collected prospectively.Group differences between JI and GPU patients,and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables.Differences with a P-value<0.05 were considered statistically significant.RESULTS Nine GPU patients and eleven JI patients were included.Median age at follow-up was 21.5 years and 24.4 years,respectively.Reflux was reported in six GPU patients(67%)vs four JI patients(36%)(P=0.37).Dysphagia symptoms were reported in 64%of JI patients,compared to 22%of GPU patients(P=0.09).Contrast studies showed dilatation of the jejunal graft in six patients(55%)and graft lengthening in four of these six patients.Endoscopy revealed columnar-lined esophagus in three GPU patients(33%)and intestinal metaplasia was histologically confirmed in two patients(22%).No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia.Three GPU patients(33%)experienced severe feeding problems vs none in the JI group.The median body mass index of JI patients was 20.9 kg/m^(2) vs 19.5 kg/m^(2) in GPU patients(P=0.08).CONCLUSION The majority of GPU patients had reflux and intestinal metaplasia in 22%.The majority of JI patients had dysphagia and a dilated graft.Follow-up after ER for LGEA is essential.

Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia

Background:This study was to analyze outcomes of long-gap esophageal atresia(LGEA)treated with partial gastric pull-up(PGP)into the thorax.Methods:The medical records of all children who had undergone PGP for LGEA from 1999 to 2012 were reviewed.Preoperative data,initial postoperative course,complications,time to full oral nutrition,follow-up diagnostics and nutritional status were assessed.Results:Nine children who had undergone PGP were followed up for a mean period of 6.2±3.1 years.Their median gestational age was 37+2 weeks,and mean birth weight 2462±658 g.Eight children were primarily treated with a gastrostomy,their mean age at PGP was 11.4+10.9 weeks and mean weight was 4484+1966 g.Their mean operation time was 199+51 minutes.Leakage was an early postoperative complication in three children,one of whom had a consecutive stricture resection.Late complications were stenosis(n=7)and gastro-esophageal reflux(n=5).The general status of the children was judged as"good"or"very good"on the last presentation.The median percentile of the body-mass-index was 25.Gastroscopy at 3.7±3.2 years after the operation revealed a grade I esophagitis in two children.There was no death in this group of children.Conclusions:Because of its high complication rate,partial gastric pull-up cannot be recommended as an alternative for the treatment of LGEA at present.A final judgment could be made on the basis of a comparative study.

Improvement of Physical Fitness Test Assessment Criteria Based on fNIRS Technology:Taking Pull-Up as an Example

Pull-up,as an important physical fitness test event of the“National Student Physical Health Standard”,is known as a difficult physical fitness test event.To improve the assessment criteria of pull-ups,this paper uses the functional near-infrared spectroscopy(fNIRS)to monitor the changes and activation of oxyhemoglobin(HbO)signals in the brain motor cortex of people with different body mass indexes(BMIs)during the pullup assessment.Then the relationship between BMIs and evaluation criteria is discussed.After collecting and analyzing experimental data of 18 recruited college students,it is found that the number of pull-ups performed by people with different BMIs is different when they reach the peak state of brain activation.The results of the study indicate that different assessment criteria should be adopted for different BMI groups.It is suggested that the BMI should be introduced as one of the test indexes in the examination of pull-ups event in“National Student Physical Health Standard”.

Aerodynamic, Kinematic and Control Coupling Simulation of Aircraft Maneuvering Flight

Aiming at the high angle of attack pull-up and multi-channel roll pull-up coupling problems of high maneuvering aircraft, this paper establishes the flight attitude control rate by means of unsteady flow numerical solution, dynamic unstructured nested mesh assembly method and numerical solution method of flight mechanics equation. On this basis, a virtual flight simulation platform integrating pneumatics, motion and control is established. Based on this virtual flight simulation platform, F-16 aircraft is simulated by high angle of attack pull-up flight mode and multi-channel roll pull-up coupling flight mode. Finally, the influence of rudder on the yaw control channel is investigated. The results show that the numerical virtual flight simulation platform established in this paper has the ability to simulate maneuvering flight of aircraft.