Tratamento do megaesofago pela mucosectonia conservação da tunica muscular esofagica por via cervicoabdominal

AUTOR(ES)
DATA DE PUBLICAÇÃO

1996

RESUMO

The partial or total esophagectomy without thoracotomy has been used with great frequency for the last few years to benign affections, specially in the advanced megaesophagus. Although this procedure presents advantages of avoiding the compromise of lung dynamics, it is not free of complications. Among these, we have to emphasize the opening of pleura with hemopneumothorax consequences, together the potential aggression to other organs in the mediastinum with the expressive postoperative morbidity. On the other hand, in advanced megaesophagus, stasis esophagitis can lead to carcinoma. Based on this considerations it was proposed, previously in animaIs and human beings, the removal ofthe mucosa and submucosa, by the completely invagination, without thoracotomy. The results were satisfactory in experimental surgery and encouraged the beginning of the experience in the c1inical area. Thus, the aim of the present work iritended to show, by a detailed analysis the technic of the removal of the esophageal mucosa by submucosa through muscular layer, keeping it whole, at the mediastinum, procedure performed by cervicoabdominat approach in 18 patients with grade lU and IV megaesophagus. The reconstrllction of the gastrointestinal tract by the stomach trapsposition was done through the posterior mediastinum inside the muscular layer ar by retrosternal route. The ear1y postoperative results were evaluated regarding complications, the surgi cal act duration and the time of permanence in hospital. The late results, regarding c1inical analysis, concerning the swallowing quality, the presence or not of regurgitation, changes in bowels habits, the weight evolution, satisfaction with the surgery and return to normal activity, and also by morphological and functional evaluation by x-ray studies, digestive endoscopy and thorax computerized tomography. The study allowed to conc1uded: 1) The mucosa removal by submucosa through invagination proved to be simple and viable in 94.5% of the cases. 2) The absence of bleeding, during or immediate postoperative period, originated from the bed layer muscular esophagus. 3) Low incidence ofpleura and lung complications. 4) The continuity ofthe gastrointestinal tract could be established by cervical gastroplasty in the posterior mediastinum, inside the esophagus muscular layer, in the majority ofthe patients with grade IV megaesophagus. 5) The late analysis of the postoperative period in the majority of the patients, showed good or excellent evaluation, either in the c1inical or in morphological and functional analysis

ASSUNTO(S)

tecnicas operatorias esofago - cirurgia acalasia esofagica

ACESSO AO ARTIGO

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