RU2474388C1 - Method for surgical correction of stage iv oesophageal achalasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method for oesophageal long axis extension refers to medicine, namely surgery. An intrapleural approach by Heller operation, Gottstein-Heller operation are followed by applying three lines of corrugating sutures along the oesophageal long axis with non-absorbable suture material on a right wall of the S-curved oesophagus. The sutures are sequentially tightened up and tied.

EFFECT: method provides S-curved oesophageal extension and restored functional patency.

1 ex, 2 dwg

Description

The invention relates to medicine, the field of surgery and directly to the surgical correction of achalasia of the cardia of the IV stage.

With achalasia of stage IV, surgical treatment is used. Modern surgery of cardiac achalasia is based on the proposal of Geller, who in 1913 first performed a bilateral cardiomyotomy. It consists of a longitudinal section of the muscular layers of the distal esophagus with transpleural access. In recent years, in the surgical treatment of cardiac achalasia of the IV degree, there is a tendency to radical highly traumatic operations in the form of esophagus extirpation.

The prototype of the invention is a method for surgical correction of achalasia of stage IV - Geller’s operation in the modification of Gottstein, which consists in the fact that after esophagocardiomyotomy with intrapleural access on the right, the dissected muscles are stitched in the transverse direction. The operation ended there (see Shalimov A.A., Saenko V.F. "Digestive tract surgery", Kiev "Zdorovya", 1987, p. 47-48). However, this method is not always effective in the case of an S-shaped curvature of the esophagus, because the food is delayed in the expanded curved esophagus due to the sagging of its walls (Fig. 1), which provokes the phenomena of esophagitis and, in turn, can lead to perforation of the latter and the development of purulent mediastinitis.

The objective of the claimed method is to eliminate the horizontal branch of an S-shaped crimped esophagus.

The technical result is achieved by the fact that after the completion of the Gottstein-Geller operation, three rows of corrugating sutures are placed along the axial axis of the esophagus with non-absorbable suture material on the right wall of the S-shaped curved esophagus, sequentially tightened and tied, which leads to its corrugation and straightening of the vertical axis of the esophagus, returning its anatomical form and function.

The essence of the invention lies in the fact that when tightening the corrugating joints, the right wall of the esophagus is corrugated, aligning the axial axis of the esophagus, which in turn leads to the functional usefulness of this organ, improving the quality of life of patients, the absence of clinical manifestations of cardiac achalasia.

To explain the invention, the following images are proposed:

Figure 1 shows the esophagus with corrugated sutures before tightening, where:

1 - S-shaped curved esophagus,

2 - rows of loose corrugated seams,

3 - stomach

4 - food lingering in the lumen of the esophagus.

Figure 2 shows the esophagus after tightening the corrugated joints, where:

1 - view of the esophagus after surgery,

2 - tightened corrugating seams,

3 - the stomach.

The method is as follows: after esophagocardiomyotomy according to Gottstein-Geller, transpleural access from the right to the right wall of the S-shaped curved esophagus along the axial axis imposes three rows of non-absorbable corrugating sutures (caprone 3/0) (Fig. 1-2) at a distance of 0.5-0.7 cm from each other, the length of the stitches is 0.4-0.5 cm. When tightening the sutures, the wall of the esophagus is corrugated, which leads to the elimination of the horizontal branch of the S-shaped crimped esophagus (figure 2).

Clinical example

Patient L., 25 years old, was admitted as planned with a diagnosis of Achalasia of the esophagus, stage IV. From the anamnesis it is known that he has been sick for more than 5 years, in the last year he began to note a deterioration. According to x-ray of the esophagus with contrast - achalasia of the esophagus stage IV, S-shaped esophagus. The operation was performed as planned: esophagocardiomyotomy according to Gottstein-Geller. On the right wall of the S-shaped esophagus, 3 rows of corrugating sutures are superimposed. The postoperative period was uneventful. During the control radiography of the esophagus with contrast 7 days after the operation: the condition after the operation, the esophagus is enlarged, freely passable, no streaks of contrast were detected. The patient was examined after one year: no radiological signs of achalasia of the esophagus were detected, the clinical manifestations of the disease disappeared, the patient gained weight.

The method of straightening the vertical axis of the esophagus in the surgical correction of stage IV cardia achalasia was used in 7 patients, there were no complications associated with the use of this method.

The proposed method helps to restore the anatomical integrity of the esophagus, which in turn leads to the functional usefulness of this organ, improving the quality of life of patients, the absence of clinical manifestations of achalasia of the esophagus.

Claims (1)

The method of surgical correction of cardiac achalasia of stage IV, which consists in the fact that after esophagocardiomyotomy with intrapleural access on the right, the dissected muscles are sutured in the transverse direction (Gottstein-Heller operation), characterized in that after completing the Gottstein-Heller operation, three rows of corrugating sutures along the axial axis are superimposed the esophagus with non-absorbable suture material on the right wall of the S-shaped curved esophagus, sequentially tighten and tie.

Images