Life before and after

The developed technique of the operation includes a total demuskulyarizatsiyu narrowed esophagus with selective proximal vagotomy (SPV) and the formation of invaginated valve kardioezofagealnoy zone and in the following manner. Under endotracheal anesthesia, laparotomy was performed verhnesredinnuyu. After the audit produce PWV mobilization of abdominal, vnutrihiatusnogo esophagus. In the transition zone kardioezofagealnogo spend a total demuskulyarizatsiyu esophagus and cardia of the stomach throughout the restricted area by preserving the vagus nerves. To do this, perform cross-circular miotomnye incisions: one at 10 mm proximal to the narrowing and the other at 10 mm distal to kardioezofagealnogo transition serosa and muscle fibers to dissect submucosal layer. Speaking about the direction miotomnyh cuts should be made clear that, unlike the distal incision, which traditionally follows the contour kardioezofagealnogo transition, lying 10 mm below it, a proximal circular incision is located at an angle of 60-70 ° in the frontal plane (Fig. 3, a) .

With this direction of the cuts during a comparison of tissue cross-linking formed an acute angle branch block (closest to the anatomical), which is another constituent component of the antireflux mechanism. Without opening the lumen of the esophagus produce a complete removal of the circular muscle sheet, and adventive serous membranes of the esophagus and stomach, after which the lower edge of the muscular layer of the esophagus and the sero-muscular cialis without prescription layer of the stomach impose nodal-taped seams, and tying that produce alternate immersion submucosal mucus-box in lumen of the stomach, thereby forming invaginated areflyuksny valve (Fig. 3, b).

Formation of invaginated areflyuksnogo brand viagra online valve and restore the anatomical angle branch block in order to prevent the occurrence of complications associated with reflux of acidic gastric contents into the esophagus.

In all 39 patients had a favorable early postoperative period. Average length of hospital stay after surgery was 6,5 ± 1,2 days.

In the early postoperative period in 1 (2.6%) patients came paresis of the vocal cords in response to tracheal intubation, which was fully docked in the first 3 days after surgery using nootropics, vitamins of group B. No other complications associated with the technique of the operation , we have not observed. Enteral nutrition in all patients started on the third day after surgery, symptoms of dysphagia in response to receiving a liquid or solid food was observed.

All patients were examined during the period from 1.5 months to 5 years after surgery.

Recurrence of the disease have been reported. All patients were of working age return to former job in terms from 12 to 16 days. Duration of disability was on average 14,2 ± 1,3 days.

Fibroezofagogastroskopiya on day 6 after surgery: the esophagus was free to pass on the level of esophageal opening is invaginated valve to close, easy access, no mucosal defects. In the stomach, a small amount of liquid. When viewed from the cardiac portion of retrogradely visible characteristic invaginated circular fold up to 11-15 mm with moderate hyperemia, edema, mucosal defect was not determined.

These examination after 3 years and 5 years after surgery: esophageal mucosa throughout is not changed, cardia wink at his retrograde examination of visible characteristic invaginated circular fold up to 15 mm in the form of a cone, covering tightly tube endoscope - a pale pink, shiny , with no visible defects. Gastroesophageal reflux is not detected in any of the observation (Fig. 4).

X-rays in the late period (from 1 to 5 years): the contrast mass flow into the stomach through the esophageal-gastric junction portions. Expansion of the esophagus is not. Cardia opens up to 15-17 mm, completely bound generic viagra up in all patients. Gas bubble in the stomach is expressed well in all patients. In a study of patients in the Trendelenburg position casting of the contrast mass in the esophagus were observed (Fig. 5).

The study of quality of life before and after surgery on a scale GIQLI, showed a significant improvement in patients, especially in the late periods. So, if prior to surgery the average score on a scale GIQLI was 89,6 ± 6,9, a year after the correction - 121,9 ± 5,2. In this case, a positive result was observed for all five scales: overall subjective perception of their health, mental and physical condition, social and role functioning (Fig. 6).

Thus, the developed method of surgical treatment of achalasia cardia II-III stage, consisting in total demuskulyarizatsii restricted area without opening the esophageal lumen of the body, excluding the possibility of one of the most severe complications - anastomotic failure; shaped invaginated valve retains organic and functional consistency, ensuring the prevention of recurrence and a high level of quality of life of patients in the late postoperative period.

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