Sohodeb R. Surgical treatment of combined afterburn strictures of esophagus and the stomach.

The thesis is about new complex , individualised treatment tactics for patients with combined afterburn stricture of esophagus and the stomach. 125 patients were investigated for the work, who were admitted with the above pathology at the institute of urgent and general surgery, AMS Ukraine .The patients were divided into main group ( 62 patients ) and comparative group ( 63 patients ). Our analysis shows that for patients with this pathology , firstly the stomach passage should be restored. From the results of investigations of protein bonded Oxyproline in the blood system of patients with chemical burns of the esophagus ,it is evident that there is a systemic activation of collagen proteins. The rate of activation of these proteins differs for patients with afterburn strictures and for those who completely rehabilitate after chemical burns. The main goal is to restore the patient's feeding. New and already known methods are used ( pneumodilatation, with electro dissection of the scar, resection of antrum with retrocolic gastroentero anastomosis, double gastroenterostomy with the formation of enterogastrostomy). Enterogastrostomy is found to be more convenient for patients as there were no skin maceration, no leakage of gastric content, no tube to take care of, and there is always a possibility for retrograde dilatation. The patients were always more comfortable in the society and this helped their rehabilitation. On the basis of the analysis of each methods - advantages and disadvantages, concrete indications for each, new individualised algorithm of treatment for patients with this pathology were found. Esophagoplasty after restoration of stomach passage by suggested methods are justified, and has been carried out in 85,5% of patients. This type of operations helped us to restore the physiology of the upper gastrointestinal tract and to decrease the rate of complications from 9,5% to 2,6% and the rate of recurrence from 15,9% to 5,3%.