PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ANASTOMOSIS IN ESOPHAGOPLASTY

Abstract

Summary. Aim. Improving the results of surgical treatment in patients with esophageal stenosis to prevent cervical anastomotic leaks and strictures after esophagoplasty by early detection, prediction of complications and development of comprehensive treatment program. Materials and methods. The results of surgical treatment of 116 patients with esophageal strictures operated on from 2005 to 2022 were analyzed. Indications to esophagoplasty were the following: post-burn strictures – in 45 patients, peptic strictures – in 10, postoperative strictures – in 17 and esophageal tumors – in 44 patients. Results and discussion. Using the method of logistic regression it was found that the most important risk factors for cervical anastomotic leak in esophagoplasty are anemia, decreased albumin level – less than 25 g/l, diabetes mellitus, complete esophageal obstruction. Treatment of patients using the proposed program and instrumental method of forming anastomosis was found to reduce the risk of complications. A comprehensive program of surgical treatment consisting of three stages was developed and used in clinical practice. At the first stage, preoperative preparation aimed at correction of all forms of metabolism was performed and the developed method of prevention of ischemic complications of grafts for esophagoplasty was used. At the second stage, improved mobilization technique in creation of gastric tube and colonic graft were used intraoperatively, as well as the developed instrumental method of forming cervical esophago-organ anastomosis. At the third stage of postoperative period the proposed infusion therapy was continued and stenting was performed in case of specific complications. Cervical anastomotic leak occurred in 4.92 % of patients in experimental group as compared to 16.36 % of those in comparison group. Cervical anastomotic leak occurred most commonly in gastric tube esophagoplasty, than in colon patch esophagoplasty (p<0.001). No cases of anastomotic leak occurred in formation of cervical anastomosis using the proposed instrumental method. Strictures of cervical anastomosis occurred in 6.56 % of patients in experimental group and 20.0 % of those in comparison group. Strictures of cervical anastomosis were observed more often in gastric tube esophagoplasty, than in colon patch esophagoplasty (p<0.001). Conclusions. The use of proposed diagnostic and therapeutic algorithm as well as comprehensive program of surgical treatment resulted in reduced incidence of leaks and strictures of esophago-organ anastomosis from 36.36 % to 11.48 % (р<0.01); reduced time of hospitalization – from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), decreased postoperative period – from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality rate – from 7.27 % to 3.28 %.