Prevention of Leaks and Strictures of Esophago-Organ Anastomosis in Esophagoplasty

Notwithstanding modern achievements in reconstructive surgery of the esophagus, intensive care, progress in modern clinical pharmacology, anesthesiology and reanimation, the results of such operations are still considered unsatisfactory. One of the most severe complications leading to the development of postoperative empyema and sepsis is anastomotic leakage, occurring in 9%-17% of cases. In long-term postoperative periodthe leaks lead to the development of esophago-organ anastomotic strictures, requiring repeated restorative interventions. The aim of the work was to decrease the incidence of leaks and strictures of esophago-organ anastomosis in esophagoplasty by predicting the risk of their occurrence and using the developed method of anastomosis formation. 116 patients with esophageal strictures were included in the study: 45 patients had post-burn strictures, 10-peptic strictures, 17-postoperative strictures and 44 patients -esophageal cancer. The most significant predictors of postoperative complications were identified by modeling the risk of their development using logistic regression method. In experimental group of patients, an individual approach to the choice of surgical intervention method was applied using an improved diagnostic and treatment algorithm with prediction of complication risk, the developed instrumental method of esophago-organ anastomosis creation. The results of operative treatment for esophageal strictures showed early post-operative complications to develop in 60 patients (51.72 %). There were six deaths: four patients in the control group and two patients – in experimental group. The use of diagnostic and treatment algorithm with prediction of complication risk, the developed method for creation of esophago-organ anastomosis was associated with steady postoperative improvement in general clinical and laboratory parameters. Leaks and strictures of cervical esophago-organ anastomosis occurred in 7 patients (11.48 %) of experimental group and 15 patients (27.27 %) of the control group (p