Novikov Y. Formation of esophageal anastomoses in view of prevention of anastomotic leakage and cicatricial strictures.

The thesis is devoted to the prevention of esophageal anastomotic leakage and stricture of esophageal anastomosis in the surgical treatment of deseases of the esophagus and stomach, complicated with it's stenosis and acute gastrointestinal bleeding. The basis of the thesis was to analyze 311 patients with deseases of the esophagus and stomach, complicated with it's stenosis and acute gastrointestinal bleeding. These patients had undergone operations with formation of esophageal anastomosis. Comprehensive study of patients and analysis of results of surgical treatment allowed to allocate factors that can determine the degree of risk of developing of anastomotic leakage and postoperative cicatricial anastomotic stricture. The system for forecasting of the development of esophageal anastomotic leakage and postoperative cicatricial esophageal anastomotic stricture was developed, based on the identified risk factors of these complications, according to the degree of their risk, which in turn determined the medical-surgical tactics in these patients. By studying and comparing of groups with different surgical treatments it was proved effectiveness of the algorithm of comprehensive individualized surgical approach in these patients on the base of the elaborated system for forecasting of the development of complications such as esophageal anastomotic leakage, postoperative esophageal anastomotic stricture and measures for their prevention with usage of improved antireflux methods of formation of esophageal anastomoses. This algorithm allowed to reduce numbers of postoperative complications such as esophageal anastomotic leakage from 7.9% to 2.5%, postoperative cicatricial esophageal anastomotic stricture, - from 16.4% to 6.3%. Postoperative mortality from esophageal anastomotic leakage is declined from 4% to 0%.