SURGICAL TACTICS FOR FAILURE OF STAPLER ESOFAGO-ESOFAGOANASTOMOSIS DURING ESOPHAGASTRIC DEVASCULARIZATION
Abstract
Background. Being currently regarded as treatment options shunt and non-shunt surgeries help to achieve the prevention of recurrent esophageal variceal bleeding. Non-shunt operations are easier to perform than shunt ones, and they are associated with a lower risk of developing encephalopathy in the postoperative period. Objective – to analyze the results of laparoscopic esophagogastric devascularization with esophageal stapler transection followed by conversion to a thoracolaparotomic resection of the distal third of the esophagus and proximal resection of the stomach. Material and methods. Laparoscopic esophagogastric devascularization with esophageal stapler transection followed by conversion to a thoracolaparotomic, resection of the distal third of the esophagus and proximal resection of the stomach due to an extensive defect in the area of the stapler esophageal suture was performed at the Grodno University Hospital in February 2019 in a patient with alcoholic liver cirrhosis, portal hypertension and recurrent bleeding from esophageal varices. Results. The patient was discharged for outpatient treatment; there was no recurrence of bleeding from esophageal varices during the follow-up period of 12 months. Laparoscopic esophagogastric devascularization with esophageal stapler transection, being an effective operation for the treatment and prevention of esophageal varices bleeding, is associated in some cases with complications arising from circular stapler malfunction. Conclusions. Timely intraoperative diagnostics of these situations involving a thorough examination of the esophageal anastomosis area, leakage tests, surgeons’ awareness of remedial surgery techniques in case of complications, and their readiness to use them, can prevent fatal outcomes.References
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