MD1104Z - Method for treating esophageal diverticulum - Google Patents
Method for treating esophageal diverticulum Download PDFInfo
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- MD1104Z MD1104Z MDS20160080A MDS20160080A MD1104Z MD 1104 Z MD1104 Z MD 1104Z MD S20160080 A MDS20160080 A MD S20160080A MD S20160080 A MDS20160080 A MD S20160080A MD 1104 Z MD1104 Z MD 1104Z
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- diverticulum
- esophageal
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- neck
- esophagus
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- 208000006707 Esophageal Diverticulum Diseases 0.000 title claims abstract description 19
- 238000000034 method Methods 0.000 title claims description 13
- 206010013554 Diverticulum Diseases 0.000 claims abstract description 16
- 210000004877 mucosa Anatomy 0.000 claims abstract description 8
- 238000001885 myotomy Methods 0.000 claims abstract description 7
- 206010011985 Decubitus ulcer Diseases 0.000 claims abstract description 5
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 5
- 238000001514 detection method Methods 0.000 claims abstract description 4
- 230000023597 hemostasis Effects 0.000 claims abstract description 4
- 210000003205 muscle Anatomy 0.000 claims abstract description 4
- 230000003447 ipsilateral effect Effects 0.000 claims description 5
- 208000008423 pleurisy Diseases 0.000 claims 1
- 210000003238 esophagus Anatomy 0.000 abstract description 11
- 238000001356 surgical procedure Methods 0.000 abstract description 8
- 239000003814 drug Substances 0.000 abstract description 3
- 210000003679 cervix uteri Anatomy 0.000 abstract 2
- 210000004224 pleura Anatomy 0.000 abstract 1
- 230000007547 defect Effects 0.000 description 6
- 230000001936 parietal effect Effects 0.000 description 5
- 230000002980 postoperative effect Effects 0.000 description 5
- 208000019505 Deglutition disease Diseases 0.000 description 3
- 208000035965 Postoperative Complications Diseases 0.000 description 3
- 229910052788 barium Inorganic materials 0.000 description 3
- DSAJWYNOEDNPEQ-UHFFFAOYSA-N barium atom Chemical compound [Ba] DSAJWYNOEDNPEQ-UHFFFAOYSA-N 0.000 description 3
- 201000010099 disease Diseases 0.000 description 3
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 3
- 238000002224 dissection Methods 0.000 description 3
- 206010067171 Regurgitation Diseases 0.000 description 2
- 230000004807 localization Effects 0.000 description 2
- 230000001483 mobilizing effect Effects 0.000 description 2
- 230000007170 pathology Effects 0.000 description 2
- 238000011477 surgical intervention Methods 0.000 description 2
- 208000011580 syndromic disease Diseases 0.000 description 2
- 208000006687 Esophageal Fistula Diseases 0.000 description 1
- 208000006588 Pleural Empyema Diseases 0.000 description 1
- 208000012287 Prolapse Diseases 0.000 description 1
- 238000004500 asepsis Methods 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 238000003759 clinical diagnosis Methods 0.000 description 1
- 230000001010 compromised effect Effects 0.000 description 1
- 230000007423 decrease Effects 0.000 description 1
- 238000011257 definitive treatment Methods 0.000 description 1
- 230000001627 detrimental effect Effects 0.000 description 1
- 230000007560 devascularization Effects 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000007717 exclusion Effects 0.000 description 1
- 238000002695 general anesthesia Methods 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 238000007689 inspection Methods 0.000 description 1
- 230000002045 lasting effect Effects 0.000 description 1
- 230000003387 muscular Effects 0.000 description 1
- 231100000915 pathological change Toxicity 0.000 description 1
- 230000036285 pathological change Effects 0.000 description 1
- 210000003281 pleural cavity Anatomy 0.000 description 1
- 230000000291 postprandial effect Effects 0.000 description 1
- 230000001737 promoting effect Effects 0.000 description 1
- 238000002271 resection Methods 0.000 description 1
- 238000010561 standard procedure Methods 0.000 description 1
- 239000000758 substrate Substances 0.000 description 1
- 230000001228 trophic effect Effects 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
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Abstract
Description
Invenţia se referă la medicină, în special la chirurgie şi poate fi utilizată pentru tratamentul chirurgical al pacienţilor cu diverticul esofagian. The invention relates to medicine, in particular to surgery and can be used for the surgical treatment of patients with esophageal diverticulum.
Este cunoscută metoda chirurgicală de tratament al diverticulului esofagian, care constă în efectuarea toracotomiei, mobilizarea diverticulului esofagian cu disecţia colului diverticular şi rezecţia lui la acest nivel, aplicarea ulterioară a unei contraincizii de esomiotomie. În cadrul ei, după anestezia generală şi aseptizarea obişnuită a câmpului operator cu pacientul în poziţie de decubit lateral (drept sau stâng în dependenţă de localizarea diverticulului), se efectuează toracotomia laterală şi inspecţia regiunii operatorii, se aplică sonda oro-gastrică, se mobilizează diverticulul până la nivelul colului, se aplică sutura mecanică pe mucoasa esofagiană şi se efectuează esomiorafia la acest nivel, ulterior se efectuează mobilizarea circulară a esofagului pe aproximativ 4…5 cm şi contralateral nivelului de localizare a diverticulului pe sonda oro-gastrică se efectuează o incizie sero-musculară longitudinală pe traiectul esofagian, se drenează cavitatea pleurală, se efectuează toracorafia şi se aplică pansamentul aseptic [1]. The surgical method of treatment of esophageal diverticulum is known, which consists of performing thoracotomy, mobilizing the esophageal diverticulum with dissection of the diverticular neck and its resection at this level, subsequent application of an esomyotomy counterincision. Within it, after general anesthesia and the usual asepsis of the operating field with the patient in the lateral decubitus position (right or left depending on the location of the diverticulum), lateral thoracotomy and inspection of the operating region are performed, an orogastric tube is applied, the diverticulum is mobilized up to the neck level, mechanical suture is applied to the esophageal mucosa and esomeorrhaphy is performed at this level, subsequently circular mobilization of the esophagus is performed for approximately 4…5 cm and contralateral to the level of localization of the diverticulum on the orogastric tube a longitudinal sero-muscular incision is made on the esophageal tract, the pleural cavity is drained, thoracorrhaphy is performed and an aseptic dressing is applied [1].
Dezavantajele acestei metode constau în aceea că în procesul de mobilizare a esofagului şi diverticulului se devascularizează excesiv o porţiune de esofag, astfel devine vulnerabil procesul de vindecare şi sunt favorizate complicaţiile inflamator-infecţioase. Această cascadă evolutivă este explicată prin tipul de vascularizaţie a esofagului, care nu are un afluent magistral, dar este aprovizionată cu sânge printr-o reţea vasculară de tip periferic-circular pe tot traiectul lui, astfel devascularizarea circulară a esofagului îl face susceptibil pentru diverse modificări de trofică, iar posibilitatea lezării mucoasei esofagiene prin incizia contralaterală la acest nivel devine un triger care conduce spre apariţia de fistule esofagiene şi empiem pleural contralateral. Deci toate aceste modificări patologice vor avea o acţiune nefastă asupra evoluţiei obişnuite a bolii, astfel creşte riscul apariţiei complicaţiilor şi perioada de tratament postoperator în staţionar cu efect economic negativ. Un neajuns se consideră şi excluderea efectuării miotomiei la nivelul colului diverticular după disecţia acestuia, astfel nu este posibilă o miorafie raţională ce ar rezolva rezonabil defectul parietal la acest nivel, deci nu poate fi lichidat locusul parietal cu minimă rezistenţă. Pe de altă parte, incizia contralaterală utilizată în tehnica clasică creează un locus nou de rezistenţă minimă, astfel riscul apariţiei unui nou diverticul la acest nivel este destul de mare. The disadvantages of this method are that in the process of mobilizing the esophagus and diverticulum, a portion of the esophagus is excessively devascularized, thus making the healing process vulnerable and promoting inflammatory-infectious complications. This evolutionary cascade is explained by the type of vascularization of the esophagus, which does not have a magisterial tributary, but is supplied with blood through a peripheral-circular vascular network along its entire path, thus the circular devascularization of the esophagus makes it susceptible to various trophic changes, and the possibility of damaging the esophageal mucosa through the contralateral incision at this level becomes a trigger that leads to the appearance of esophageal fistulas and contralateral pleural empyema. Therefore, all these pathological changes will have a detrimental effect on the usual evolution of the disease, thus increasing the risk of complications and the period of postoperative inpatient treatment with a negative economic effect. A shortcoming is also considered the exclusion of performing myotomy at the diverticular neck level after its dissection, thus a rational myorrhaphy that would reasonably resolve the parietal defect at this level is not possible, so the parietal locus cannot be eliminated with minimal resistance. On the other hand, the contralateral incision used in the classical technique creates a new locus of minimal resistance, thus the risk of the appearance of a new diverticulum at this level is quite high.
Problema pe care o rezolvă invenţia dată constă în rezolvarea raţională, definitivă a diverticulului esofagian la orice nivel. Pacienţii postoperator au un rezultat foarte bun demonstrat la examenul clinic (prin absenţa disfagiei şi a regurgitaţiilor) şi paraclinic (prin examen radiologic) în toate cazurile, astfel încât substratul anatomo-patologic al bolii (defectul parietal esofagian cu prolabarea mucoasei esofagiene) este definitiv abolit. The problem solved by this invention consists in the rational, definitive resolution of the esophageal diverticulum at any level. Postoperative patients have a very good result demonstrated by clinical examination (by the absence of dysphagia and regurgitation) and paraclinical examination (by radiological examination) in all cases, so that the anatomo-pathological substrate of the disease (esophageal parietal defect with prolapse of the esophageal mucosa) is definitively abolished.
Esenţa metodei constă în aceea că pacientului, în poziţie de decubit lateral drept sau stâng în dependenţă de localizarea diverticulului, i se efectuează toracotomia laterală cu depistarea diverticulului esofagian, se aplică sonda oro-gastrică, se disecă punga diverticulului până la colul ei, se secţionează circular stratul submucos, după care în partea inferioară a diverticulului esofagian, ipsilateral, de la colul lui se efectuează miotomia longitudinală a muşchilor esofagieni pe o distanţă de 1,5…2 cm, apoi mecanic se suturează mucoasa esofagiană cu secţionarea ulterioară a sacului diverticular, se efectuează miorafia cu aplicarea suturilor separate, se pleurizează această regiune cu controlul hemostazei, se efectuează revizia şi drenarea cavităţii toracice cu un dren de 24 Fr, apoi toracorafia. The essence of the method is that the patient, in the right or left lateral decubitus position depending on the location of the diverticulum, undergoes a lateral thoracotomy with detection of the esophageal diverticulum, an orogastric tube is applied, the diverticulum sac is dissected up to its neck, the submucosal layer is circularly sectioned, after which in the lower part of the esophageal diverticulum, ipsilateral, from its neck, a longitudinal myotomy of the esophageal muscles is performed over a distance of 1.5…2 cm, then the esophageal mucosa is mechanically sutured with subsequent sectioning of the diverticular sac, myorrhaphy is performed with the application of separate sutures, this region is pleurized with hemostasis control, revision and drainage of the thoracic cavity with a 24 Fr drain are performed, then thoracorrhaphy.
Avantajele metodei constau în aceea că se rezolvă rezonabil (prin efect bun şi de durată) defectul parietal. În tehnica propusă nu este necesară mobilizarea circulară a esofagului, astfel nu este compromisă trofica lui şi sunt eficace prevenite complicaţiile postoperatorii, iar recidivele postoperatorii nu se atestă. De asemenea această tehnică facilitează cu mult manipulaţiile intraoperatorii şi scade timpul necesar intervenţiei chirurgicale, iar absenţa complicaţiilor postoperatorii face ca sejurul pacienţilor în staţionar să fie de 2…3 zile postoperator, ceea ce face ca această metodă să fie rentabilă şi din punct de vedere economic pentru instituţiile medicale. Utilizarea inciziei inferioare ipsilaterale rezolvă definitiv defectul muscular esofagian, iar prin renunţarea la o contraincizie de miotomie esofagiană nu se realizează defecte noi şi astfel este suprimată posibilitatea apariţiei unor noi locusuri de minimă rezistenţă. The advantages of the method are that it reasonably resolves the parietal defect (through good and lasting effect). In the proposed technique, circular mobilization of the esophagus is not necessary, thus its trophism is not compromised and postoperative complications are effectively prevented, and postoperative relapses are not attested. Also, this technique greatly facilitates intraoperative manipulations and decreases the time required for surgical intervention, and the absence of postoperative complications makes the patient's stay in the hospital 2…3 days postoperatively, which makes this method cost-effective and economically viable for medical institutions. The use of the ipsilateral lower incision definitively resolves the esophageal muscular defect, and by waiving an esophageal myotomy counterincision, no new defects are created and thus the possibility of new loci of minimal resistance is suppressed.
Rezultatul tehnic constă în tratamentul definitiv al diverticulului esofagian la orice nivel, cu închiderea rezonabilă a defectului parietal, cu risc minim de complicaţii postoperatorii şi fără recidive la distanţă, care este argumentată atât teoretic, cât şi practic, astfel că pacienţii postoperator au rezultate bune în 100% cazuri. The technical result consists of the definitive treatment of the esophageal diverticulum at any level, with reasonable closure of the parietal defect, with minimal risk of postoperative complications and without distant relapses, which is argued both theoretically and practically, so that postoperative patients have good results in 100% of cases.
Invenţia se explică prin fig. 1…3, care reprezintă: The invention is explained by Fig. 1…3, which represent:
- fig. 1, disecţia pungii diverticulare, miotomia longitudinală inferioară ipsilaterală; - Fig. 1, diverticular pouch dissection, ipsilateral inferior longitudinal myotomy;
- fig. 2, suturarea mucoasei esofagiene; - Fig. 2, suturing of the esophageal mucosa;
- fig. 3, suturarea seroasei. - Fig. 3, suturing of the serosa.
Exemplu de realizare a invenţiei Example of embodiment of the invention
După aseptizarea câmpului operator, cu pacientul în poziţie de decubit lateral drept sau stâng în dependenţă de localizarea diverticulului, se efectuează toracotomia laterală cu depistarea diverticulului esofagian, se aplică sonda oro-gastrică, se disecă punga diverticulului până la colul ei, se secţionează circular stratul submucos, după care în partea inferioară a diverticulului esofagian, ipsilateral (fig.1), de la colul lui se efectuează miotomia longitudinală a muşchilor esofagieni pe o distanţă de 1,5…2 cm, apoi mecanic se suturează mucoasa esofagiană (fig.2) cu secţionarea ulterioară a sacului diverticular, se efectuează miorafia cu aplicarea suturilor separate, se pleurizează această regiune cu controlul hemostazei (fig.3), se efectuează revizia şi drenarea cavităţii toracice cu un dren de 24 Fr şi se efectuează toracorafia, apoi se aplică pansament aseptic. After asepticizing the operating field, with the patient in the right or left lateral decubitus position depending on the location of the diverticulum, a lateral thoracotomy is performed with detection of the esophageal diverticulum, an orogastric tube is applied, the diverticulum sac is dissected up to its neck, the submucosal layer is circularly sectioned, after which in the lower part of the esophageal diverticulum, ipsilateral (Fig. 1), from its neck, a longitudinal myotomy of the esophageal muscles is performed over a distance of 1.5…2 cm, then the esophageal mucosa is mechanically sutured (Fig. 2) with subsequent sectioning of the diverticular sac, myorrhaphy is performed with the application of separate sutures, this region is pleurized with hemostasis control (Fig. 3), revision and drainage of the thoracic cavity with a 24 Fr drain is performed and thoracorrhaphy is performed, then an aseptic dressing is applied.
Exemplu Example
Pacientul X., în vârstă de 47 de ani. Diagnosticul clinic: diverticul esofagian în 1/3 inferioară stângă. La internare: clinic - disfagie, disconfort postprandial şi în poziţie de clinostatism timp de 13 ani; la examenul paraclinic prin radiografia cu substanţă baritată a esofagului - diverticul esofagian în 1/3 inferioară stângă, cu diametrul de 2 cm, pe bază lată. Patient X., 47 years old. Clinical diagnosis: esophageal diverticulum in the lower left 1/3. On admission: clinically - dysphagia, postprandial discomfort and in a supine position for 13 years; on paraclinical examination by barium x-ray of the esophagus - esophageal diverticulum in the lower left 1/3, with a diameter of 2 cm, on a broad base.
A fost efectuată intervenţia chirurgicală conform metodei revendicate. The surgical intervention was performed according to the claimed method.
La externare: absenţa semnelor de sindrom esofagian (fără disfagie şi regurgitaţii), la examenul radiologic baritat al esofagului - esofagul în 1/3 distală fără patologie diverticulară. La 3 luni, 6 luni şi ulterior 1 an, după intervenţia chirurgicală, la examenul clinico-paraclinic (examenul radiologic baritat şi FEGDS videoasistată) fără recidivă de diverticul esofagian. At discharge: absence of signs of esophageal syndrome (no dysphagia and regurgitation), on barium x-ray examination of the esophagus - the esophagus in the distal 1/3 without diverticular pathology. At 3 months, 6 months and subsequently 1 year, after surgery, on clinical-paraclinical examination (barium x-ray examination and video-assisted FEGDS) without recurrence of esophageal diverticulum.
Metoda dată de tratament chirurgical a fost aplicată la 35 pacienţi cu diverticul esofagian cu localizare diversă ( în 1/3 superioară şi inferioară, de dreapta şi de stânga), în cadrul catedrei de chirurgie Nr. 4 DECM, Universitatea de Stat de Medicină şi Farmacie "Nicolae Testemiţanu” IMSP Spitalul Clinic Republican, secţia chirurgie toracică. Aceasta şi-a dovedit pe deplin eficacitatea şi tinde să rămână metoda standard de tratament în patologia dată. Toţi pacienţii supuşi acestei intervenţii - clinic şi paraclinic, atât în perioada postoperatorie imediată la 3, 6 luni, cât şi după 1 an, au suprimat totalmente sindromul esofagian cauzat de un diverticul. This method of surgical treatment was applied to 35 patients with esophageal diverticulum of various localization (in the upper and lower 1/3, right and left), within the Department of Surgery No. 4 DECM, "Nicolae Testemiţanu" State University of Medicine and Pharmacy, Republican Clinical Hospital, Thoracic Surgery Department. It has fully proven its effectiveness and tends to remain the standard method of treatment in this pathology. All patients subjected to this intervention - clinically and paraclinically, both in the immediate postoperative period at 3, 6 months, and after 1 year, completely suppressed the esophageal syndrome caused by a diverticulum.
1. Siewert J.R., Holscher A. Diseases of the esophagus, Spinger-Verlang, Haidelberg. 1999, p. 1096-1176 1. Siewert J.R., Holscher A. Diseases of the esophagus, Spinger-Verlang, Heidelberg. 1999, p. 1096-1176
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| Application Number | Priority Date | Filing Date | Title |
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| MDS20160080A MD1104Z (en) | 2016-06-16 | 2016-06-16 | Method for treating esophageal diverticulum |
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| MDS20160080A MD1104Z (en) | 2016-06-16 | 2016-06-16 | Method for treating esophageal diverticulum |
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| MD1104Z true MD1104Z (en) | 2017-07-31 |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2701388C1 (en) * | 2018-12-28 | 2019-09-26 | Государственное бюджетное учреждение здравоохранения города Москвы Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения города Москвы | Method for endoscopic treatment of esophageal diverticulum |
| RU2787707C2 (en) * | 2022-06-16 | 2023-01-11 | Федеральное государственное бюджетное учреждение "Национальный медицинский исследовательский центр радиологии" Министерства здравоохранения Российской Федерации (ФГБУ "НМИЦ радиологии" Минздрава России) | Method for preventing failure of mechanical seam of esophagus |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1159563A1 (en) * | 1983-12-21 | 1985-06-07 | Центральный Ордена Ленина Институт Усовершенствования Врачей | Method of plasty of throat defects and cervical part of esophagus |
| SU1178414A1 (en) * | 1983-07-13 | 1985-09-15 | Научно-Исследовательский Институт Экспериментальной И Клинической Хирургии Им.Акад.К.Д.Эристави | Method of plasty of the cervical section of esophagus |
| SU1289504A1 (en) * | 1985-04-19 | 1987-02-15 | Московский городской научно-исследовательский институт скорой помощи им.Н.В.Склифосовского | Method of treatment of nonmalignant destructive injures of esophagus wall |
| SU1412746A1 (en) * | 1985-08-22 | 1988-07-30 | Смоленский государственный медицинский институт | Method of treatment of cervical section of esophagus |
-
2016
- 2016-06-16 MD MDS20160080A patent/MD1104Z/en not_active IP Right Cessation
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1178414A1 (en) * | 1983-07-13 | 1985-09-15 | Научно-Исследовательский Институт Экспериментальной И Клинической Хирургии Им.Акад.К.Д.Эристави | Method of plasty of the cervical section of esophagus |
| SU1159563A1 (en) * | 1983-12-21 | 1985-06-07 | Центральный Ордена Ленина Институт Усовершенствования Врачей | Method of plasty of throat defects and cervical part of esophagus |
| SU1289504A1 (en) * | 1985-04-19 | 1987-02-15 | Московский городской научно-исследовательский институт скорой помощи им.Н.В.Склифосовского | Method of treatment of nonmalignant destructive injures of esophagus wall |
| SU1412746A1 (en) * | 1985-08-22 | 1988-07-30 | Смоленский государственный медицинский институт | Method of treatment of cervical section of esophagus |
Non-Patent Citations (1)
| Title |
|---|
| Siewert J.R., Holscher A. Diseases of the esophagus, Spinger-Verlang, Haidelberg. 1999, p. 1096-1176 * |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2701388C1 (en) * | 2018-12-28 | 2019-09-26 | Государственное бюджетное учреждение здравоохранения города Москвы Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения города Москвы | Method for endoscopic treatment of esophageal diverticulum |
| RU2787707C2 (en) * | 2022-06-16 | 2023-01-11 | Федеральное государственное бюджетное учреждение "Национальный медицинский исследовательский центр радиологии" Министерства здравоохранения Российской Федерации (ФГБУ "НМИЦ радиологии" Минздрава России) | Method for preventing failure of mechanical seam of esophagus |
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| Publication number | Publication date |
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| MD1104Y (en) | 2016-12-31 |
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