Viun S. Surgical tactics at high risk of failure of the esophageal anastomoses

The dissertation is devoted to solving the problem of improvement of the treatment results of patients with high risk of incontinence of the esophagus and intestinal anastomoses, by improving preoperative preparation and surgical tactics, aimed at reducing postoperative complications and mortality. The work is based on the analysis of the results of surgical treatment of 157 patients with RH. Measures for preoperative preparation, which included PDT, and surgical tactics with gastrectomy with unloading yunostomy were developed. The scale of risk assessment for the development of the insolvency of the SCA has been developed. For each degree of risk was offered its own method of treatment. Preoperative preparation was supplemented with photodynamic therapy, which reduced the number of insolvencies from 12% in the comparison group to 6.7% in the main group. It is proved that at high risk of SCA insolvency it is expedient to perform gastrectomy with unloading eunostomy. The developed complex program of successive measures allowed to significantly reduce the risk of failure of the esophagus and ananastomosis, even with the complicated flow of RH and improve the immediate results of surgical treatment of gastric cancer by reducing the mortality rate in the early postoperative period from 10.8 to 4.2%.