scholarly journals Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis

2021 ◽  
Vol 102 (6) ◽  
pp. 951-959
Author(s):  
D V Senichev ◽  
R A Sulimanov ◽  
R R Sulimanov ◽  
E S Spassky ◽  
S A Salekhov
Keyword(s):  
Surgical Treatment ◽  
Spontaneous Rupture ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Esophageal Wall ◽  
Esophageal Rupture ◽  
Spontaneous Esophageal Rupture ◽  
Surgical Methods ◽  
Mediastinal Drainage ◽  
Mediastinal Vessels

Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, blind mediastinal drainage. The second group (n=23) consisted of patients treated with programmed re-thoracotomy. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's 2 test. Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis 1.5 times, mortality almost 2 times. Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

scholarly journals A New Method of Boerhaave Syndrome Surgical Treatment and Its Experimental Justification

2018 ◽  
Vol 11 (3) ◽  
pp. 193-201
Author(s):  
Md all Rayhan ◽  
Viktor Viktorovich Bulynin ◽  
Alexander Ivanovich Zhdanov ◽  
Yuri Alexandrovich Parkhisenko ◽  
Borich Efimovich Leibovich
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Pleural Cavity ◽  
Operation Time ◽  
Esophageal Wall ◽  
Time Interval ◽  
Esophageal Rupture ◽  
Spontaneous Esophageal Rupture ◽  
Boerhaave Syndrome ◽  
Experimental Justification

Relevance. Spontaneous esophageal rupture (Boerhaave syndrome) is observed relatively rare ranging from 2.9% to 12% of all cases of damage of the esophagus. Today, there is not any categorical opinion about the effectiveness of different treatments among surgeons, there are not any single algorithms for the diagnosis and evaluation of treatment. Spontaneous esophageal rupture is a real threat for the life of patient: mortality up to 75% in the prehospital period and more than 90% in the postoperative period, and depends on the time interval between the rupture of the esophageal wall and the operation time, and also complications (suppurative esophagitis, suppurative mediastinitis, bilateral suppurative lobular pneumonia, sepsis). Purpose. To improve results of surgical treatment of patients with spontaneous esophageal rupture using the results obtained in the experiment. Materials and methods. Since 2004 till 2017 twelve patients with spontaneous esophageal rupture were treated in our hospital. Ways of treatment of lower third of esophageal rupture: drainage of pleural cavity – 2 patients; closure of the defect, fundoplication with covered stitches by the bottom of the stomach – 2 patients; perforated hole was not sutured, and a cuff, covering the perforation, was formed from the bottom of the stomach (fundoplication by Chernousov) – 8 patients. These methods of surgical treatment were applied in the experiments on 120 rats. Each group consisted of 40 rats. Results and discussion. The pleural cavity drainage, lethality – 1 (50%) patient. The suturing of the defect of the esophageal walls, the fundoplication with the stitches, covered by the bottom of the stomach, failure of stitches – 2 patients, lethality – 1 (50%) patients. The perforated hole was not sutured, and the cuff was shaped from the bottom of the stomach, covering the perforation. Lethality – 2 (25%) patients, caused by bilateral pneumonia in contrast to progressive sepsis. Other patients operated on this method didn’t have any failure of stiches. In the experiment: in the 1st group the failure of stitches was 87.5% and lethality – 100%; in the 2nd group the failure of stitches was 85% and lethality – 100%; in the 3rd group  there was not any failure of stitches, lethality – 17.5%. Conclusions. The most effective method of treatment is the restoration of rupture esophagus without suturing, and forming a cuff from the bottom of the stomach, covering the perforation. Drainage of pleural cavity and nutrition through a nasogastric tube.

Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

2021 ◽  
Author(s):  
Ceren Cesur ◽  
Ayşenur Celayir
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
X Rays ◽  
Surgical Methods ◽  
Pull Through ◽  
Subacute Intestinal Obstruction

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

P166 SPONTANEOUS ESOPHAGEAL RUPTURE – BOERHAAVE SYNDROME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B  Movchan ◽  
O Usenko ◽  
A Zgonnyk ◽  
R Vynogradov
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Clinical Manifestations ◽  
Esophageal Rupture ◽  
Esophageal Stents ◽  
Spontaneous Esophageal Rupture ◽  
Timely Diagnosis ◽  
Boerhaave Syndrome ◽  
Surgical Tactics ◽  
Effective Drainage

Abstract Aim To study the most effective method of treatment in patients with spontaneous rupture of the esophagus. Background The timely diagnosis of Boerhaave syndrome presents great difficulties due to its rarity, a variety of clinical manifestations, often simulating different pathologies from other organs and are difficult to treat. Methods From 2003 to 2019 9 patients with Bourhave's syndrome were treated at the clinic, primary care was provided to 6 patients in the community. All patients were admitted to the clinic with external left-sided esophageal-pleural fistula, 1 patient had a spontaneous rupture of the esophagus in the cliniс, the defect of the esophagus wall defect was completed, which led to successful results. Results Treatment in the remaining patients was started with adequate enteral nutrition and effective drainage of the pleural cavity. As a result of the use of pleural double-lumen drainage with active sanation with antiseptics and subsequent aspiration, with the exception of feeding through the mouth in four patients, it was possible to eliminate the esophageal-pleural fistula, profuse bleeding and death of the patient. Against the background of ongoing conservative therapy in two patients, it was not possible to eliminate the esophago-pleural fistula. A left-sided thoracotomy was performed with excision of the fistula with the decortication of the lung and the extirpation of the esophagus with the formation of an esophagostomy. Subsequently, these patients underwent retrosternal colic esophagoplasty. Two patients underwent Lewis surgery with drainage of the pleural cavity. Conclusion Boerhaave syndrome has a very high mortality rate, however, with a timely diagnosis and adequate surgical tactics, it develops into the formation of an esophageal-pleural fistula. In this case, the most effective treatment is excision of the fistulous course with extirpation of the esophagus and subsequent esophagoplasty. The use of esophageal stents is possible in extremely depleted patients or in elderly patients, due to the frequent occurrence of hypergranular esophagitis. Esophageal stents should be removed as soon as possible when confidence in the elimination of the esophageal-pleural fistula occurs.

scholarly journals Various surgical techniques for the treatment of inflammatory diseases of the periodontium

2014 ◽  
Vol 21 (1) ◽  
pp. 71-74 ◽  
Author(s):  
S. B. Ulitovskiy ◽  
O. V. Galibin ◽  
V. V. Tomson ◽  
A. V. Antipova ◽  
A. D. Vilesov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Present Article ◽  
Inflammatory Diseases ◽  
Periodontal Diseases ◽  
Surgical Techniques ◽  
Treatment And Prevention ◽  
Surgical Methods

The inflammatory periodontal diseases (IPD) take the second place after caries of teeth therefore the questions of treatment and prevention of IPD are especially actual. In the IPD treatment are the most effective, it is possible to allocate the surgical methods. In the present article questions of improvement of traditional techniques of surgical treatment, and also development and deployment of the new are considered.

scholarly journals The Role of Operation in the Treatment of Boerhaave’s Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Dingpei Han ◽  
Zhuoqiong Huang ◽  
Jie Xiang ◽  
Hecheng Li ◽  
Junbiao Hang
Keyword(s):  
Surgical Treatment ◽  
Length Of Stay ◽  
Treatment Strategy ◽  
Time Interval ◽  
Esophageal Rupture ◽  
Spontaneous Esophageal Rupture ◽  
Appropriate Treatment ◽  
Age Range ◽  
Primary Healing

Purpose. This study aims to discuss the appropriate treatment strategy for spontaneous esophageal rupture. Methods. Clinical data from twenty-one cases were retrospectively analyzed. The parameters included etiology, time interval between onset and treatment, therapy methods, prognosis, and length of stay. Results. The ratio of males/females was 17/4, age range was 32–82 years (mean = 43.1), and the time interval between onset and treatment was as follows: <24 h: nine cases (42.8%); 24–48 h: six cases (28.6%); and >72 h: six cases (28.6%). All patients underwent operative treatment, and the following primary healing rates were achieved: <24 h: 88.9%, 24–48 h: 66.7%, and >72 h: 0. No patients died in this study. All patients were discharged with recovery, and the average hospitalization times were 18.1 days (<24 h), 27.8 days (24–48 h), and 51.2 days (>72 h). Conclusions. Surgical treatment remains an effective method for treating spontaneous esophageal rupture, and the shorter the time interval between onset and treatment, possibly the better the prognosis.

scholarly journals Results of treatment for Boerhaave syndrome

2019 ◽  
Vol 27 (1) ◽  
pp. 66-74
Author(s):  
Aleksey V. Mikheev ◽  
Sergey N. Trushin
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Spontaneous Rupture ◽  
Surgical Intervention ◽  
Esophageal Rupture ◽  
Results Of Treatment ◽  
Boerhaave Syndrome ◽  
The Moment ◽  
Suture Failure

Background. Spontaneous rupture of the esophagus (Boehaave syndrome, BS) is a rare pathology in the surgical practice. Esophageal rupture makes no more than 2-3% of all cases of damage to the esophagus and is associated with a significant number of diagnostic errors and with high mortality. Aim. The aim of the study was to analyze the quality of diagnostics and the results of treatment of patients with spontaneous rupture of the esophagus. Materials and Methods. We performed a retrospective analysis of medical histories and of treatment results of 10 patients with Boerhaave syndrome hospitalized in the department of thoracic surgery of the Ryazan Regional Clinical Hospital, Ryazan in 2007-2018. Results. Four of ten patients were transferred from other medical institutions. At the primary care stage six patients were misdiagnosed; two of them underwent diagnostic laparoscopy for suspicion of acute pancreatitis and perforated gastric ulcer. The average time from the onset of the disease to surgery was 71.723.4 hours. Closure of the esophageal perforation was performed in all cases. Regarding the timing of surgery, all patients with Boerhaave syndrome were divided into 2 groups: patients with early intervention (4 patients operated within 24 hours); patients with late intervention (5 patients operated after 48 hours from the onset of the disease). One patient underwent surgical treatment within 24 hours in a medical facility outside the Ryazan region. In nine out of ten patients the rupture was localized in a typical place in the lower third of the esophagus along the left lateral wall. In the postoperative period eight patients had complete or partial esophageal suture failure, which required prolonged inpatient treatment (54.712.1 days). Postoperative mortality was 10% (1 patient of 10) and was caused by the progressive multi-organ failure and the development of cerebral ischemic stroke. Conclusion. The quality of diagnostics of Boerhaave syndrome remains unsatisfactory: due to rare occurrence of this pathology, most specialists of primary care settings, including surgeons, are not well acquainted with the etiopathogenesis and peculiarities of clinical presentation of Boerhaave syndrome. Diagnostic and treatment errors in rendering primary medical assistance reaches 60%. Results of surgical treatment directly correlate with the time from the moment of perforation and development of septic complications. Even with early surgical intervention performed within 24 hours from the moment of perforation, esophageal suture failure may occur in up to 75% of cases. Thus, the success of treatment is determined by early diagnosis, timely hospitalization in a specialized facility, and adequate surgical intervention.

scholarly journals Surgical techniques used for tonsil disease in children

2015 ◽  
Vol 62 (3) ◽  
pp. 294-297
Author(s):  
A. Zamfir-Chiru-Anton ◽  
◽  
D.C. Gheorghe ◽  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Surgical Techniques ◽  
The Other ◽  
Intraoperative Blood Loss ◽  
Advantages And Disadvantages ◽  
Surgical Methods ◽  
Surgical Options ◽  
The Difference

The authors review the techniques described for the surgical treatment of the tonsils. Each new method has its own advantages and disadvantages. The difference can be evaluated by studying the intraoperative blood loss and safety of the procedure. Also, the postoperative complications and quality of life can be used as an adjunct to objectively appreciate the different surgical techniques. There is no literature consensus about the superiority of one technique over the other. Multiple studies brought multiple significant results. It is also hard to evaluate the entire panel of surgical methods described concomitantly. The experience of one surgeon and his/her mastering of a certain technique is the actual cause of so many surgical options still in use for tonsil treatment in children.

scholarly journals Recurrent, Spontaneous Esophageal Ruptures Associated With Antiphospholipid Antibody Syndrome: Report of a Case

2014 ◽  
Vol 99 (6) ◽  
pp. 842-845 ◽  
Author(s):  
Hiroshi Naitoh ◽  
Minoru Fukuchi ◽  
Shinsuke Kiriyama ◽  
Takaharu Fukasawa ◽  
Yuichi Tabe ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
English Literature ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Esophageal Rupture ◽  
Vascular Thrombosis ◽  
Spontaneous Esophageal Rupture ◽  
Increased Risk ◽  
Boerhaave Syndrome ◽  
Syndrome Report

Abstract A 52-year-old man was admitted to our hospital with a spontaneous esophageal rupture (Boerhaave syndrome) and was successfully treated. Eight years after the first incident, he was readmitted with a recurrent rupture. Recurrence of Boerhaave syndrome is extremely rare, with only 7 cases reported in the English literature. During treatment, the patient was also diagnosed with antiphospholipid syndrome (APS). Although APS is known to cause a variety of symptoms due to vascular thrombosis, recurrence of Boerhaave syndrome, coincident with APS, has never been reported. The pathogenesis of Boerhaave syndrome has not been clearly determined. This report serves to increase awareness of the risk of APS, which results in an increased risk of spontaneous rupture of the esophagus.

scholarly journals A Case of Spontaneous Esophageal Rupture Treated with Laparoscopic Mediastinal Drainage

2019 ◽  
Vol 80 (8) ◽  
pp. 1465-1469
Author(s):  
Yuka KOSEKI ◽  
Yoshiyuki SUZUKI ◽  
Hiroto FUJISAKI ◽  
Yuki SEO ◽  
Ryosuke HARA ◽  
...  
Keyword(s):  
Esophageal Rupture ◽  
Spontaneous Esophageal Rupture ◽  
Mediastinal Drainage
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