EZOFAGOSTOMYYa (Greek oisophagos a gullet + stoma of companies, an opening, pass) — operation of creation of outside fistula of a gullet. Usually is the final stage of difficult interventions concerning diseases and lovrezhdeniye of a gullet, as a rule with a resection of its part.
For the first time in 1877. V. Czerny imposed ezofagosty after a successful resection of cervical department of a gullet concerning cancer. In 1913 Mr. F. J. A. Thorek suggested to remove a stump of a gullet via the hypodermic tunnel away from an operational wound, F. Zauerbrukh (1925) sewed a proximal stump of a gullet in a bottom corner of a cervical wound. Both of these techniques with success are applied and now. In 1956 J. Johnson, etc. suggested to bring at the ruptures of a wall of a gullet complicated by a mediastinitis (see) the proximal and distal ends of the crossed gullet to a side surface of a neck in the form of a double ezofagostoma. In 1970 Abbott (O. of A. Abbott), etc. at a spontaneous gap naddi-afragmalny department of a gullet drained a gleam of a gullet the T-shaped tube with removal of the long end of a drainage through a pleural sine on a chest wall, creating a side ezofagostoma on an extent. In the past applied also imposing of fistula on a diverticulum of cervical department of a gullet at its inflammation (operation Bella — Nikoladoni).
The indication to imposing of an ezofagostoma are radical operations for cancer of a gullet (see), ruptures of a gullet or insolvency of seams after operation with development of a mediastinitis (see) when sewing up of an opening in a wall of a gullet is impossible; at the weakened, exhausted children at operations for an atrezna of a gullet with inborn esophageal and tracheal fistulas when plastic surgery is made in several stages.
Depending on the level of crossing of a gullet of an ezofagostom it can be brought to a neck (cervical E.), chest wall (chest E.) or abdominal wall (abdominal E.). Ezofagostoma can be proximal (removal of the oral end of a gullet) and distal (removal of the aboral end).
Cervical E. carry out at an extirpation of a gullet more often. At the same time the proximal stump of a gullet is removed in a bottom corner of a cervical wound; in some cases the stump is carried out in the hypodermic tunnel away from an operational wound on a front chest wall at the level of II — the III edges. The stump of a gullet is fixed in a skin wound noose catgut sutures, and the muscular layer of a wall of a gullet is sewed with a hypodermic muscle of a neck, a mucous membrane — with edge of skin. To Ezofagosty close a friable bandage to provide free outflow of saliva. Food of patients is carried out through a gastrostomy (see the Gastrostomy).
The patients who transferred cervical E., use the slyunopriyemnik consisting of a silicone cap with the wide basis covered for the best prileganiye to skin with adherent layer. In a cap there is a side union, on to-ry put on a silicon drainage tube 20 — 25 cm long. On other its end the plastic sack for collecting saliva is fixed. The cap is put on on ezofagosty and fixed a band around a neck. The tank for collecting saliva is located under clothes.
At chest E. a distal part of chest department of a gullet after partial mobilization is brought out of-plevralno or chresplevralno to a chest wall, the proximal end is brought to a neck. At chest E. feeding of patients is carried out through a gastrostomy.
In nek-ry cases at the weakened children at operations for an atresia of a gullet and inborn esophageal and tracheal fistulas resort to creation of an abdominal ezofagostoma with removal of a distal stump of chest department of a gullet on an abdominal wall. After performance of the main stage of operation and imposing of a cervical ezofagostoma will mobilize a distal piece of a gullet, expand an esophageal opening of a diaphragm, reduce a stump of a gullet in an abdominal cavity and create ezofagosty on a front abdominal wall in left hypochondrium. At abdominal E., and in nek-ry cases and at chest (in distal department of a gullet) feeding of patients is carried out through ezofatosty.
Cm also Gullet, operations;
E zo f agate iya.
Bibliography: Amosovn. M. Sketches of thoracic surgery, page 641, Kiev, 1958; B and and r about in G. A. Urgent surgery of newborns, L., 1963; Mosquitoes
B. D., Kanshinn. N and Abakumov M. M. Injuries of a gullet, M., 1981; Operational surgery, under the editorship of. I. Litt-manna, the lane with Wenger., page 180, Budapest, 1981; Petrovsky B.V. and d river. Treatment of damages and fistulas of a gullet, Surgery, No. 7, page 7, 1976; B. S rose trees. Foreign bodys and injuries of a gullet and related complications, M., 1961; Shalimov A. A., With and e N to about V. F. and Shalimov S.A. Surgery of a gullet, M., 1975; Abbott O. And. and. lake of Atraumatic so-called «spontaneous» rupture of the esophagus, J. thorac. cardiovasc. Surg. v. 59, p. 67, 1970; Johnson J., S with h w e-g m a n C. W. a. K i r b at S. K. of Esophageal exclusion for persistent fistula following spontaneous rupture of the esophagus, ibid., v. 32, p. 827, 1956; OsterH, Wic-keW. u.WolnerE. Verletzungen der Speiserohre, Wien. klin. Wschr., S. 218, 1978; SauerbruchE.F. Die Chirurgie der Brustorgane, Bd 2, B., 1925; T or e k F. The first successful resection of the thoracic portion of the esophagus for carcinoma, J. Amer. med. Ass., v. 60, p. 1533, 1913.
M. M. Abakumov.