Novosti
Khirurgii

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Year 2022 Vol. 30 No 6

GENERAL & SPECIAL SURGERY

A.N. IHNATSIUK, A.S. KARPITSKI

TREATMENT OF PERFORATIONS OF THE THORACIC ESOPHAGUS

Healthcare Institution «Brest Regional Clinical Hospital», Brest,
Republic of Belarus

Objective. To improve the results of treatment of esophageal perforations by using the current minimally invasive video-assisted thoracoscopic technologies.
Methods. The patients (n=54) underwent the treatment: 41 (75.9%) men and 13 women (24.1%). The average age of patients was 52 years. The causes of perforations are as follows: spontaneous rupture of the esophagus − 21 (38.9%); foreign body of the esophagus - 9 (16.7%); cancer − 2 (3.7%); iatrogenic damage - 5 (9.3%); cardiodilatation with achalasia of the cardia - 2 (3.7%); bougie stricture of the esophagus with reflux esophagitis − 1 (1.9%); swelling of the scar-altered esophagus due to chemical burn of the esophagus - 14 (25.9%). The average time from the initial clinical manifestations to surgery was 24 hours. The discrepancy between the primary diagnosis and the final one was revealed in 23 (42.6%) patients. All patients (n=54) were operated on. 47 (87%) patients were discharged in satisfactory condition, 7 (13%) died.
Results. Pre-operative factors affecting the tactics of surgery: «coincidence of the primary diagnosis with the main one»; «diagnosis» and «distance from incisors to esophageal perforation» was determined. The best treatment results in the groups using the «controlled fistula» method were obtained. Thus, in the upper and middle thoracic regions, the optimal method was to fix the drainage at the site of esophageal perforation, in the lower thoracic region - the installation of a T-shaped drainage system.
Conclusion. The method of choosing surgical treatment depends on the correct primary diagnosis, the level of perforation and the main cause of esophageal perforation. In the absence of «compromised» esophagus in the treatment of its perforation, minimally invasive thoracoscopic intervention provides the best results by reducing the duration of rehabilitation, improving the quality of life and reducing mortality rate. The conducted clinical study made it possible to improve the treatment outcomes of patients with esophageal perforation in various pathologies.

Keywords: esophageal perforation, T-shaped drainage system, fixation of the transpleural tube, extirpation of the esophagus.
p. 552-561 of the original issue
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Address for correspondence:
224027, Republic of Belarus,
Brest, 7 Meditsinskaya str.,
Brest Regional Clinical Hospital,
Department of Thoracic Surgery,
tel.: +375298054971,
e-mail: alexihnatsiuk@gmail.com,
Ignatsiuk Aliaksandr N.
Information about the authors:
Ignatyuk Alexander N., Applicant of the Department of General Surgery of the Educational Establishment «Grodno State Medical University», Surgeon of the Department of Thoracic Surgery of the Educational Institution «Brest Regional Clinical Hospital», Brest, Republic of Belarus.
https://orcid.org/0000-0002-8925-380X
Karpitsky Alexander S., MD, Professor, Chief Physician of the ME «Brest Regional Clinical Hospital», Brest, Republic of Belarus.
https://orcid.org/0000-0001-8205-8959
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