DOZ047.29: Pleural flap for partial esophageal substitution in case of difficult anastomosis

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S De Napoli Cocci ◽  
S Faraj ◽  
A Guinot ◽  
S Joseph ◽  
D Caldari ◽  
...  
Keyword(s):  
Oral Feeding ◽  
Esophageal Reconstruction ◽  
Esophageal Wall ◽  
Parietal Pleura ◽  
Partial Reconstruction ◽  
Esophageal Tissue ◽  
Complications Of Surgery ◽  
Esophageal Substitution ◽  
Anterior Plane

Esophageal reconstruction in long-gap atresia remains challenging for the surgeon. Complications of surgery, regardless of choices and methods proposed, are frequents, sometimes serious, and can significantly delay baby's feeding, with increased disruption of orality. The ideal is a reconstruction with only esophageal tissue available. There is renewed interest for technical of elongation described initially by Foker, especially modified by Van Der Zee.1 But, elongation is not always so simple that provided. We report an observation of esophageal atresia (type 1 Ladd), treated by rapid elongation. On the sixth day of procedure, right pleurisy reveals a rip at the apex of inferior esophagus. Anastomosis was possible on the posterior plane, but impossible on the anterior plane. The anterior plane has been reconstituted with a flap of parietal pleura. The operative course was simple without any fistula. Oral feeding started at fifteenth day postanastomosis was quickly complete. Gastrostomy left by security has not been used. Three endoscopic dilations have been necessary at six weeks, two and five months after anastomosis. At the age of eleven months, the orality was perfect, and diet was diversified with pieces. Use a pleural flap to bury or isolate sutures is well known technic.2 But use only pleura to replace the esophageal wall is not described. Partial reconstruction of a hemiesophageal wall with only pleura is possible, despite difficult conditions. It is a trick easily achievable in case of difficulty, with a good result that is maintained over time.

scholarly journals Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report

2020 ◽  
Vol 8 ◽  
Author(s):  
Roberto Tambucci ◽  
Océane Wautelet ◽  
Astrid Haenecour ◽  
Geneviève François ◽  
Christophe Goubau ◽  
...  
Keyword(s):  
Median Sternotomy ◽  
Oral Feeding ◽  
Surgical Reconstruction ◽  
Esophageal Reconstruction ◽  
Surgical Approaches ◽  
Long Distance ◽  
Esophageal Tissue ◽  
Diseased Segment ◽  
Foregut Malformation ◽  
Long Gap Esophageal Atresia

Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called “esophageal trachea,” which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.

DOZ047.99: A unique case of ‘esophageal trachea’ requiring a multistep sequential surgical reconstruction

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
R Tambucci ◽  
O Wautelet ◽  
G François ◽  
A Haenecour ◽  
C Goubau ◽  
...  
Keyword(s):  
Common Duct ◽  
Median Sternotomy ◽  
Oral Feeding ◽  
Surgical Reconstruction ◽  
Esophageal Reconstruction ◽  
Surgical Approaches ◽  
Distal Stump ◽  
Esophageal Tissue ◽  
Gastric Transposition ◽  
Long Gap Esophageal Atresia

Abstract Introduction Communicating bronchopulmonary foregut malformations (CBPFMs) have been defined by Srikanth et al. in 1992 as a fistula between a portion of respiratory tissue and esophagus/stomach. Four types of CBPFMs have been described, none of those contemplating a complete communication between the distal trachea and esophagus. Case Report This study reports a case of a full-term neonate presenting with a VACTERL association and a tracheoesophageal malformation characterized by the presence of a long common duct including both the middle esophagus and distal trachea, which consists in esophageal tissue, without any cartilaginous rings 3–4 cm above the carina. A few days after birth, the esophagus and trachea have been surgically separated, keeping the common duct on the tracheal side and creating a residual long-gap esophageal atresia (LGEA). The resulting severe tracheomalacia has been simultaneously treated by posterior splinting using an autologous pericardium patch, as well as by anterior aortopexy. A terminal esophagostomy and a gastrostomy have been created to postpone esophageal reconstruction. Since the age of 18 months, delayed repair of LGEA has been performed by using a multistep strategy consisting of a combination of Kimura extrathoracic esophageal elongations and distal stump Foker external traction. Since no cartilaginous rings were present, refractory tracheomalacia has been further treated by a tracheoplasty through a combined median sternotomy and tracheoscopy approach at the age of 3 years by using a semitubular rigid Gore-Tex® prosthesis for an anterior external stenting. Today, 9 months after last surgery, complete weaning from respiratory support has been stably achieved, as well as full oral feeding. Conclusions This is the first description of an ‘esophageal trachea’, which may be considered as a new anatomic variant of CBPFMs. Multidisciplinary medical and surgical expertise was needed to manage this particular case, in order to properly plan multiple sequential surgical approaches. Native esophageal reconstruction should always be considered, even because colonic or gastric transposition might further affect severe tracheomalacia, resulting in more challenging treatment.

Technical Aspects in Esophageal Lengthening: An Investigation of Traction Procedures and Suturing Techniques in Swine

2018 ◽  
Vol 29 (05) ◽  
pp. 481-484 ◽  
Author(s):  
Christina Oetzmann von Sochaczewski ◽  
Evangelos Tagkalos ◽  
Andreas Lindner ◽  
Hauke Lang ◽  
Axel Heimann ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Mechanical Stability ◽  
Breaking Strength ◽  
Esophageal Wall ◽  
Dorsal Wall ◽  
Technical Aspects ◽  
Usp 4 ◽  
Esophageal Tissue ◽  
Traction Suture ◽  
Suturing Techniques

Introduction Traction procedures are useful to preserve the child's own esophagus in long-gap forms of esophageal atresia. To date, it remains unclear what suture size or position of the traction sutures is optimal to account for differences in anatomy and to reduce the risk of traction sutures being torn out of the esophageal tissue. Materials and Methods Explanted porcine esophagi (from swine aged 100–120 days and weighing 100–120 kg) were divided at the carinal level. Traction sutures were either placed circumferentially or only in the dorsal wall and the breaking strength—circumferential disruption of the muscular layer—was measured. Suture size (USP 4–0 vs. 5–0) was also evaluated in a similar way. Results Neither traction suture position did not influence breaking strengths between circumferentially placed traction sutures or those exclusively placed in the dorsal esophageal wall (Δ = 0.47 N, 95% confidence interval: −2.83 to 3.76 N, p = 0.771, n = 11 per group) nor differing suture sizes of USP 4–0 and USP 5–0 (Δ = 1.46 N, 95% confidence interval: −3.2 to 0.28 N, p = 0.0946, n = 9 per group) affected breaking strengths. Conclusion Suture size and suture positioning do not affect mechanical stability in Foker's procedure and therefore can be adapted as needed according to patient's anatomy and size.

scholarly journals Evaluation of the extent of damage to the esophageal wall caused by press-through package ingestion

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6763
Author(s):  
Takuya Tamura ◽  
Hajime Okamoto ◽  
Toyoaki Suzuki ◽  
Yoichi Nakanishi ◽  
Daisuke Sugiyama
Keyword(s):  
Esophageal Injury ◽  
Esophageal Wall ◽  
Esophageal Tissue ◽  
Ingested Foreign Body ◽  
Frictional Forces ◽  
Damage Depth ◽  
Degree Of Damage ◽  
Extent Of Damage ◽  
Silicon Sheet ◽  
Scratch Tests

Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion. We pathologically evaluated porcine lower esophageal tissue using a scratch tester. Using porcine esophageal tissue, scratch tests were performed with 4 test objects and pathological damage was compared. It was assumed that each object was accidentally ingested. The objects were polyvinylidene chloride (PVDC)-coated polyvinyl chloride (PVC) PTP, soft PThPa, round PTP, and a disposable scalpel. The porcine esophagus was replaced with a silicon sheet, and an automatic friction machine was used for quantitative evaluation. The silicon sheet was scratched using HHS 2000 with 750-g load at 50 mm/min. We investigated the frictional force exerted on the surface for each of the objects. The degree of damage (depth) was the highest for the disposable scalpel, followed by PVDC-coated PVC PTP, while the degree of damage (depth) was the lowest for soft PThPa and round PTP. The mean frictional forces on the silicon sheet were 524.0 gf with PVDC-coated PTP, 323.5 gf with soft PThPa, 288.7 gf with round PTP, and 922.7 gf with the disposable scalpel. We developed approaches to qualitatively and quantitatively evaluate the risk of esophageal damage after accidental PTP ingestion. Our findings indicate that the risk of gastrointestinal damage after accidental PTP ingestion is low with soft PTP and round PTP.

scholarly journals The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

2021 ◽  
Author(s):  
Natalia Kovalerova
Keyword(s):  
Nutritional Status ◽  
Postoperative Period ◽  
Gastric Tube ◽  
Nutritional Support ◽  
Oral Feeding ◽  
Esophageal Reconstruction ◽  
Single Center ◽  
Subtotal Esophagectomy ◽  
Early Oral Feeding ◽  
Gastric Tube Reconstruction

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.

Crystalloid Inclusions in Hepatocyte Mitochondria and Their Similarity to Cytoplasmic Crystalloids

1974 ◽  
Vol 32 ◽  
pp. 198-199
Author(s):  
Odell T. Minick ◽  
Hidejiro Yokoo
Keyword(s):  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Special Interest ◽  
Structural Variations ◽  
Mitochondrial Alterations ◽  
The Matrix ◽  
Crystalloid Inclusions ◽  
Liver Biopsies

Mitochondrial alterations were studied in 25 liver biopsies from patients with alcoholic liver disease. Of special interest were the morphologic resemblance of certain fine structural variations in mitochondria and crystalloid inclusions. Four types of alterations within mitochondria were found that seemed to relate to cytoplasmic crystalloids.Type 1 alteration consisted of localized groups of cristae, usually oriented in the long direction of the organelle (Fig. 1A). In this plane they appeared serrated at the periphery with blind endings in the matrix. Other sections revealed a system of equally-spaced diagonal lines lengthwise in the mitochondrion with cristae protruding from both ends (Fig. 1B). Profiles of this inclusion were not unlike tangential cuts of a crystalloid structure frequently seen in enlarged mitochondria described below.

Evidence for a shear mechanism for the precipitation of γ-zirconium hydride in zirconium

1978 ◽  
Vol 36 (1) ◽  
pp. 658-659
Author(s):  
G.J.C. Carpenter
Keyword(s):  
Elevated Temperature ◽  
Strain Field ◽  
Zirconium Hydride ◽  
Zirconium Atom ◽  
Atom Diffusion ◽  
Solvus Temperature ◽  
Hexagonal Close Packed ◽  
Partial Dislocations ◽  
The Face

In zirconium-hydrogen alloys, rapid cooling from an elevated temperature causes precipitation of the face-centred tetragonal (fct) phase, γZrH, in the form of needles, parallel to the close-packed <1120>zr directions (1). With low hydrogen concentrations, the hydride solvus is sufficiently low that zirconium atom diffusion cannot occur. For example, with 6 μg/g hydrogen, the solvus temperature is approximately 370 K (2), at which only the hydrogen diffuses readily. Shears are therefore necessary to produce the crystallographic transformation from hexagonal close-packed (hep) zirconium to fct hydride.The simplest mechanism for the transformation is the passage of Shockley partial dislocations having Burgers vectors (b) of the type 1/3<0110> on every second (0001)Zr plane. If the partial dislocations are in the form of loops with the same b, the crosssection of a hydride precipitate will be as shown in fig.1. A consequence of this type of transformation is that a cumulative shear, S, is produced that leads to a strain field in the surrounding zirconium matrix, as illustrated in fig.2a.

Direct structure images of 30° partial dislocation cores in silicon

1987 ◽  
Vol 45 ◽  
pp. 242-243
Author(s):  
J. C. Barry ◽  
H. Alexander
Keyword(s):  
Dislocation Core ◽  
Preparation Technique ◽  
Burgers Vector ◽  
Vector Type ◽  
Sample Preparation Technique ◽  
Lattice Images ◽  
Dislocation Core Structure ◽  
Type Lattice ◽  
Direct Inspection

Dislocations in silicon produced by plastic deformation are generally dissociated into partials. 60° dislocations (Burgers vector type 1/2[101]) are dissociated into 30°(Burgers vector type 1/6[211]) and 90°(Burgers vector type 1/6[112]) dislocations. The 30° partials may be either of “glide” or “shuffle” type. Lattice images of the 30° dislocation have been obtained with a JEM 100B, and with a JEM 200Cx. In the aforementioned experiments a reasonable but imperfect match was obtained with calculated images for the “glide” model. In the present experiment direct structure images of 30° dislocation cores have been obtained with a JEOL 4000EX. It is possible to deduce the 30° dislocation core structure by direct inspection of the images. Dislocations were produced by compression of single crystal Si (sample preparation technique described in Alexander et al.).

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