Korolevska A. Surgical tactics in patients with extended cicatricial esophageal strictures.

The dissertation contains theoretical basis and offers a practical solution for a scientific problem – improvement of the surgical treatment results of the patients with extended post-burn cicatricial esophageal strictures by the existing surgical tactics improvement and development of modified surgical interventions in patients with such pathology. The conducted researches allowed to develop the surgical treatment tactics of patients with extended post-burn cicatricial esophageal strictures and to substantiate the obligatory indications to perform the transchiatal esophagoplasty with the formation of single antireflux anastomosis and stoma on the neck. It was proved that the indications to perform the developed new methods of reconstructive surgical treatment esophagoplasty in patients with extended post-burn esophageal strictures such as one-step esophagoplasty and esophagoplasty as step II in patients with formed modified contact gastrostomy are the presence of extended cicatricial esophageal stricture which occupies two or more anatomical regions of the esophagus, presence of the residual dysphagia on the background of the dilatation procedures courses, absence of significant violations of nutritive status; satisfactory patient condition; laboratory and instrumental parameters are physically normal; absence of severe chronic pathology. Data of express-pH-metry with visual control and pH-Z-impedancemonitoring of upper part of gastrointestinal tract indicate the adaptation of the esophageal stump and interponate in the postoperative period. In patients of the main group the physiological nature of reflux was confirmed due to the presence of antireflux barrier. The abnormal volume and chemical clearance in the esophageal stump due to disorders of esophageal motility and evacuation was revealed in all patients of the comparison group. The performed researches prove that the usage of the proposed surgical tactics, the modified method of one-step esophagoplasty and esophagoplasty as step II in patients with formed contact gastrostomy in patients with extended post-burn cicatricial esophageal strictures is an effective instruments to improve the patients treatment results. There was a tendency of decreasing the number of postoperative early and long-term complications and mortality. The statistically significant decrease of the number of complications associated with the performed radical surgery was found during the comparative analysis. The early postoperative complications rate in patients of the main group was 10.2%, in the comparison group – 45.3% (p<0.05). The long-term postoperative complications rate in patients of the main group was 8.2% and in the comparison group – 26.4% (p<0.05). The decrease tendency of the number of local (resulted from the problem with anastomosis) and general complications was noted. It is explained by the features of surgical interventions with the usage of advanced methods of surgical treatment, as well as more effective preparation of the patients before the surgery. The postoperative mortality of the main group and the comparison group was 2.0% and 3.8% (p<0.05) respectively. The life quality indicators of the patients in the main group in the long-term postoperative period was statistically significantly higher (p<0.05) compared to patients in the comparison group.