GASTROESOPHAGOSTOMY

From Big Medical Encyclopedia

GASTROESOPHAGOSTOMY (grech, gaster stomach + oisophagos gullet + stoma of companies, opening, pass; synonym: gastroezofagoanastomoz, esophagogastrostomy, ezofagofundoanastomoz) — operation of creation of an anastomosis between a stomach and a gullet. The hl is applied. obr. at cardiostenoses of high-quality character — at a so-called cardiospasm (an achalasia of a gullet, an idiopathic esophagectasia) and the isolated cicatricial narrowing of nizhnegrudny department of a gullet. As the gullet at this operation is anastomosed, as a rule, with fundal department of a stomach, quite often this operation is called «эзофагофундоанастомоз».

In 1910 H.Heyrovsky for the first time executed, using abdominal access. The expanded suprastenotichesky site of a gullet was mobilized, reduced through an esophageal opening of a diaphragm in an abdominal cavity and anastomozirovan with a front wall of the arch of a stomach.

In 1916 Mr. N. Grondahl to avoid formation of a cul-de-sac in a gullet below an anastomosis, changed technology of operation a little. The gleam of a gullet and stomach in the field of its arch was opened not with two parallel separate cuts with preservation of cardial narrowing, and one section on the front wall of a gullet and the greater cul-de-sac hemmed to it which podkovoobrazno are bending around the connecting line of seams through the narrowed cardia (as at a pyloroplasty across Finney). After that two rows of seams created a wide ezofagofundalny anastomosis. G.'s performance in both options by abdominal access is followed by the technical difficulties limiting use of this operation. In 1942. A. G. Savinykh suggested to combine abdominal access with the sagittal diaphragmotomy giving broad access to the lower third of chest department of a gullet and considerably facilitating technology of imposing of an anastomosis. Later many surgeons began to give preference to transpleural access. Taking into account the offered modifications G. rather widely was applied in 40 — the 50th years, yielding favorable short-term results. However studying of the long-term results showed that at many patients the heavy complications connected with continuous throwing in a gullet through an anastomosis of acid gastric contents (the reflux esophagitis, round ulcers of a gullet which are followed by bleeding, peptic strictures) develop eventually. It was the cause of sharp restriction of indications to use of operation G., especially at treatment of a cardiospasm. Operation G. can be shown at the limited cicatricial strictures of an abdominal piece of a gullet which developed owing to chemical, a burn.

In some cases G. can be reasonable as the palliative operation replacing a gastrostomy at occlusive cancer esophago - a cardial zone. However in connection with technical complexity and great risk of development of insolvency of seams at cancer defeats it is applied seldom.

Insolvency of seams of an esophageal and gastric anastomosis — the main complication of G., and frequency of its development is in direct dependence on the nature of a disease and the general condition of the patient. At the operations made concerning high-quality cardiostenoses, this complication is rare (1 — 5%), and at patients with inoperable cancer insolvency of seams of an anastomosis is the main reason for a high postoperative lethality (20 — 50%).

It is possible to carry to G. also a neostomy between a gullet and a distal stump of a stomach at operation of a resection of proximal department of a stomach (see. Stomach , operations). Also some types of operations of an esophagectomy come to an end (see. Gullet , operations).


Bibliography Petrovsky B. V. Surgical treatment of a cardiospasm, Surgery, No. 2, page 3, 1957; Fedorova O. D. Cardiospasm, page 110, M., 1973; Shalimov A. A., Saenko V. F. and Shalimov S.A. Surgery of a gullet, M., 1975; E 1 1 i s F. H. a. O 1 s e n A. M. Achalasia of the oesophagus, Philadelphia a. o., 1969; Heyrovsky H. Kasuistik und Therapie der idiopathischen Dilatation der Speiserohre, Osophagogastroanasto-mose, Langenbecks Arch. klin. Chir., Bd 100, S. 603, 1913; N i s s e n R. Opera-tionen am Osophagus, Stuttgart, 1954; it, Speiserohre, Handb. d. Thorax-chirurgie, hrsg. v. E. Derra, Bd 3, T. 3, S. 883, B. u. a., 1958.

B. S. Rozanov.

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