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Content available remote Gastric Emptying in Esophageal Substitutes
For patients undergoing esophagectomy, the stomach is the organ that is most commonly used to restore continuity in the gastrointestinal tract. As a consequence of changes in stomach shape and location, patients in the postoperative period usually experience disturbed motility of the upper gastrointestinal tract of variable intensity.The aim of the study was to assess the motility of esophageal substitutes and the emptying rate of a narrowed stomach (in particular its prepyloric portion) using scintigraphy in patients undergoing esophageal resection compared to those in healthy controls.Material and methods. Between 2000 and 2006, 297 patients (105 women, 192 men) underwent surgical treatment for esophageal cancer in the Clinic of Gastrointestinal Surgery. Ten patients (average age 59; range 54 to 67 years) who underwent an attempted curative esophageal resection were selected into the study group. Patients from this group underwent scintigraphic assessment of gastric emptying between three to 11 months after the surgical procedure (an average 7 months). Furthermore, ten healthy volunteers (average age 28; range 19 to 43 years) constituted the control group.Results. The average radiotracer retention after two hours was 44.7±6.5% in the study group and 51.1±7.4% (p>0.2) in the control group. Frequency of contractions of the whole prepyloric segment, as well as its distal fragment, in the subsequent periods of examination was comparable in both groups. Correlation among the frequency of contractions, contraction duration and duration of relaxation of the whole prepyloric segment and its distal fragment was high for the control group (correlation coefficients 0.71 p<0.001; 0.71 p=0; and 0.63 p=0, respectively). In the study group, correlation between the frequency of contractions and contraction duration was poor (coefficients of correlation 0.03 p>0.8 and -0.02 p>0.9), while correlation between duration of relaxation of the whole prepyloric segment and its distal fragment was moderate (coefficient of correlation 0.34 p>0.06).Conclusions. Formation of a gastric substitute after its narrowing and denervation (truncal vagotomy) does not abolish gastric contractility. Frequency, amplitude, duration of contraction, and relaxation duration of the prepyloric portion of the ectopic substitute do not differ significantly from the patterns of motility of the upper gastrointestinal tract in healthy volunteers.
Content available Efficacy of camera sleeve in conveyance of conduits
Background: Esophageal substitutes need conveyance from the abdomen into the neck for restoration of alimentary continuity. Reports suggest that the use of plastic camera sleeve may prove advantageous in restoring conveyance. This study aims to evaluate the practicability of this approach, specifically, in laparoscopy-assisted surgeries. Methods: The efficacy of camera sleeve in conduit transposition was prospectively evaluated over 2 years. The following parameters were assessed: success/failure; time taken; blood loss; adequacy of length of the conduit delivered into the neck; conduit orientation; ease of procedure through different routes; conduit damage; complications; and drawbacks. Results: The technique was used in 25 consecutive patients. Two ileo-colonic, 13 gastric, and 10 colonic conduits were transposed. Posterior mediastinal, retro-sternal, and ante-sternal routes were used in 15, 8, and 2 cases, respectively. There were no failures. The technique was easy to adopt. It added < 10 minutes to the procedure. It entailed no additional blood loss. Adequate length of the conduit was transposed into the neck, atraumatically. Conduits maintained their orientation without effort. Although no complications per se were associated with its use, extra conduit length became transposed into the neck, twice, necessitating its trimming/adjustment. In one case, traction suture became avulsed from the conduit, midway in the tunnel. This could easily be rectified by pulling out the sleeve from the neck, which brought up the conduit along with it, as desired. Conclusions: Use of camera sleeve proves efficacious in interposition of esophageal substitutes.
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