DEHISCENCE MANAGEMENT OF THORACIC ESOPHAGUS AND ITS ANASTOMOSES
Abstract
Background. When treating the dehiscence of the esophagus and its anastomoses, it is necessary to fulfil the following tasks: drainage and sanitation of the mediastinum and pleural cavity, replenishment of protein losses and energy costs, dehiscence closure and treatment of present purulent complications. Objective. To improve the treatment outcomes of esophageal and its anastomoses dehiscence using modern minimally invasive video-assisted thoracoscopic techniques. Material and methods. 20 patients (15 (75%) men and 5 women (25%)) with esophageal and its anastomoses dehiscence underwent treatment. The mean age of patients was M±SD = 55 ± 10 (CI (95%) = 50-60; min−35; max−76). Body mass index averaged M±SD = 20.98 kg/m2 (CI (95%) = 18.61-22.45; min−15,82; max−38,27). Results. The reasons for the surgical interventions resulting in dehiscence were as follows: esophageal cancer - 6 (30.0%); esophageal diverticula - 4 (20.0%); cardia achalasia − 2 (10.0%); esophageal chemical burn − 4 (20.0%); benign formations - 4 (20.0%). The development of clinical manifestations of dehiscence occurred at M±SD = 170 ± 61 hours, (CI (95%) = 141 - 198). Conclusions. The dehiscence management of the esophagus, esophagogastroanastomosis or esophagoenteroanastomosis either by installation of a T-shaped drainage system or fixation of transpleural tube to the thoracic wall at a place of dehiscence enables to preserve the esophagus or a created conduit, to reduce surgical stress as well as the duration of intervention and is regarded as an adequate surgical option.
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