Hussein M. Prevention and treatment of complications of cervical anastomosis in esophagoplasty

The dissertation is devoted to the problem of improving the results of surgical treatment in patients with esophageal stenosis to prevent cervical anastomotic leaks and strictures after esophagoplasty by early detection, prediction of complications and development of comprehensive treatment program. The results of surgical treatment of 116 patients with esophageal strictures were analysed. Indications to esophagoplasty were the following: post-burn strictures – in 45 patients, peptic strictures (due to reflux esophagitis) – in 10, postoperative strictures – in 17 and esophageal tumors – in 44 patients. The developed instrumental method of formation of circular staple cervical esophago-organ anastomosis (useful model patent of Ukraine № 132523 of 25.02.2019), designed to be used in the neck region for performing esophagoplasty by gastric tube or colonic segment, allowed to minimise postoperative complications. A comprehensive program of surgical treatment consisting of three stages was developed and used in clinical practice. At the first stage, preoperative preparation aimed at correction of all forms of metabolism was performed and the developed method of prevention of ischemic complications of grafts for esophagoplasty was used (useful model patent of Ukraine № 141214 of 25.03.2020). The use of proposed diagnostic and therapeutic algorithm as well as comprehensive program of surgical treatment resulted in reduced incidence of leaks and strictures of esophago-organ anastomosis from 36.36 % to 11.48 % (р<0.01); reduced time of hospitalisation – from 28.2±1.1 to 21.5±0.5 bed-days (p<0.001), decreased postoperative period – from 20.5±1.1 to 16.1±0.7 bed-days (p<0.01); decreased postoperative mortality rate – from 7.27 % to 3.28 %.