Esophageal plastic surgery

The main task of the esophagus is to deliver food to the stomach, otherwise this function is called transport or motor. Also in the esophagus, lubrication of food passing through it is provided. The secret for lubrication is produced by special glands of the mucous membrane lining the organ cavity. The esophagus protects against the return of food from the stomach, that is, it helps to move food in only one direction.

If a patient is diagnosed with a serious pathology in which it is necessary to restore the structure of the esophagus, then the actions of doctors should be aimed at maximizing the preservation of the organ. In case of irreversible disorders, when there is no way to avoid surgical intervention, esophageal plastic surgery is performed.

Indications for plastic surgery of the esophagus

Indications for plastic surgery of the esophagus in the first place is the congenital absence or acquired fusion of natural openings and channels in the esophagus. Plastic surgery is also recommended for damage to the esophagus, which is caused by a long-term presence of a foreign object in it.

Often, such operations are prescribed due to burns, which manifest themselves in the form of diffuse leiomatosis and inflammatory pseudotumors. Another indication for plastic surgery of the esophagus is the lack of motor activity of the walls of the esophagus.

What is esophagoplasty

During the esophageal plastic surgery, a so-called “esophageal graft” is implanted. It must be sufficiently elastic and straight.

If the graft does not meet these characteristics, then the patient will regularly need to undergo esophagoscopy (diagnosis of the inner walls of the esophagus using an esophagoscope) and dilation. As a rule, the main purpose of the graft is to act as a passive conductor.

Whatever the plastic, it is very important that the reverse flow of the contents from the stomach into the graft itself is restored. Therefore, the best replacement for the esophagus is an implant that fully connects the esophago-gastric region with the esophagus.

The quality of the plasty is very important in order to avoid bougienage of individual sections of the esophagus.

In surgical practice, there are three main methods of esophageal plasty, namely:

• installation of a colon transplant;
• installation of a gastric tube;
• installation of a jejunal transplant.

It is not uncommon for doctors to move the stomach to the chest area.

Segmental esophagoplasty according to the method of Ostroverkhov and Toshchakov

This technique involves the excision of a segment of the required size from the small intestine, which will have one or two vascular legs. The excised segment is connected to the edge of the esophagus, at the site of the resection. Thus, the full and continuous functioning of the esophageal tube will be restored.

At the beginning of the operation, the abdominal cavity is cut and opened, and a section of the intestine is isolated, where the arcades and intestinal arteries are most pronounced, at least 9 cm long. The vessels that depart from the arcades are tied up at a distance of 30 cm, then the operation itself is performed.

During the operation, depending on the volume of resection, the esophagus can be reduced or enlarged.

The most optimal method is considered to be esophagoplasty using a graft from the left side of the colon on the left colon vessel. Such an operation is indicated for patients with a diagnosis of benign stricture.

The length and volume of the graft is sufficient to replace the entire esophagus, and sometimes even a certain part of the pharynx (of course, if there are serious indications for this).

After such a surgical intervention, the blood supply from the left colic vessel to the right is restored in patients, and the state of blood circulation is sufficient for food to pass unhindered. Also, after the operation, full-fledged anastomoses are created.

The marginal vessels and walls of the intestine itself are closely connected after surgery, so the direct graft does not increase in length with time and does not twist. In the process of digestion of solid food, the left half of the large intestine is involved, the second is less involved.

In addition, if the left half of the colon is removed, then there will be fewer problems in the future than if the right one is removed. Accumulated experimental experience shows that the colon is more resistant to acidity, so doctors very rarely diagnose ulcers in the graft. Minimally invasive video surgery has significant advantages over open access. Today, the introduction of video-surgical techniques when performing operations on the esophagus makes it possible to achieve insignificant intraoperative traumatism, minimal blood loss and early rehabilitation of patients. Apparently, there is a direct sense to perform all operations for benign diseases of the esophagus by thoracoscopic and laparoscopic methods. Everything depends mainly on organizational problems and the cost of the procedure. As for esophageal cancer, these works on the introduction of endovideosurgical techniques continue in order to clearly develop indications and contraindications for such operations and to work out the technique of lymph node dissection.

Plastic in children

For children, the situation is a little more complicated. Before choosing a plastic surgery technique, it is necessary to conduct a complete diagnosis of the child’s body. A child is allowed for surgery only if he has no problems with the cardiovascular system.

If a child had a retrosternal plasty, then in the future it is very difficult to get to the heart. Also, if the child has previously undergone heart surgery, then it is necessary to choose a different method of intervention, and not retrosternal.

If at birth the child does not have natural openings and channels in the corresponding organ, and there is no distal tracheoesophageal fistula, then surgery is possible immediately after birth to lengthen the segments of the esophagus.

Recently, however, pediatric surgeons in such cases have resorted to cervical esophagostomy and gastrostomy, but esophageal plastic surgery is performed six months after birth. In some cases, surgery may be delayed until 2 years of age.

In any case, there are advantages that have been confirmed for more than a dozen years. After conducting many such operations, experts came to the conclusion that they are best done not immediately after birth. But this statement is debatable, because if a child does not eat naturally for two to three months, that is, not through the mouth, then perhaps he will get used to this and will never eat normally.

Therefore, if a child has a gastrostomy, then feeding should be carried out through a hole in the wall of the organ and through the mouth. Thus, the stomach will be fully filled, and the child will develop the habit of eating through the mouth and he will learn to swallow. It is very important to always diagnose pathological processes in the body in a timely manner. Thus, serious consequences and complications can be avoided. Remember that timely preventive examinations are the key to your health.

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