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CNAA / Theses / 2006 / June /

The choice of surgical methods, plastic materials and operative techniques in esophagoplasty

Author: Nicolae Gladun
Degree:doctor habilitat of medicine
Speciality: 14.00.27 - Surgery
Scientific council:


The thesis was presented on the 14 June, 2006
Approved by NCAA on the 29 June, 2006


Adobe PDF document1.70 Mb / in romanian


CZU 616.329-089.44

Adobe PDF document 16.00 Mb / in romanian
260 pages


The reconstructive surgery of esophagus is one of the most difficult branches of gastroesophageal surgery.

Modern achievements of medicine in diagnoses, present-day level of technical abilities of surgery and deep knowledge of pathophisiology used in intensive therapy and anesthesiology resulted in qualitative change in this branch of surgery. The actuality of this problem consists in an increasing of esophageal pathology, which needs the resection of esophagus with following reconstruction. The goal of this research was the amelioration of results of surgical treatment and improvement of quality of live of patients undergoing esophagoplasty by the choice of adequate surgical intervention, reconstructive materials, and the perfection of operative techniques and conducting of postoperative period.

The scientific work is based on the analyses of proper clinical material on the base of the department of thoracic surgery Clinical Republican Hospital from 1977 till 2005 years. There were analyzed the results of treatment of 182 patients, which undergone different types of esophagoplasty: small intestine graft-55, large intestine graft -89, stomach graft -31, combined method- 5, plastic with local tissue- 2.

Patients had undergone clinical, laboratorial and instrumental examinations which were possible in the republican clinic.

The indications for esophagoplasty were:

The reconstruction of esophagus with jejunal graft was done in 55 patients, as a rule, by two actions, intrapleural variant, and jejunal loop with the length till the arc of azygos vein (52 cases). The pathological changed part of esophagus was removed in all the cases with obligatory pyloroplasty.

The segmental plastic was done in 3 cases by the transplantation of segment of jejunal graft with vascular anastomoses on the neck.

The large intestine was used for esophagoplasty in 89 cases.

It was used as by –pass variant in postcaustical stenosis of esophagus in 73 cases (in combined burns of esophagus and inferior part of pharynx -16 cases).

The extirpation of esophagus was done in 10 cases.

Ileocolonoplasty was used in 14 patients, colon in antiperistaltic variant in 7patients, colon in isoperistaltic variant in 68 patients.

The graft was placed retrosternal (after breast) in 75 cases, in posterior mediastinum- 9 cases, intrapleural plastic-4 cases, presternal position (subcutaneous tunnel) -2 cases.

The stomach was used for esophagoplasty in 31 patients. The operation type Lewis was done in 21 cases, Osava- Garloc –in 2 cases.

The replacement of esophagus by gastric isoperistaltic tube, which was done from greater curvature of stomach (by Kirshner-Oringer method) was used in 8 cases, by 3 accesses (laparotomy, thoracotomy, cervicotomy) in 2 cases and by 2 accesses (laparotomy, cervicotomy) in 6 cases.

The author describes and analyses in details intra- and postoperative complications. The author discusses lethal outcomes and emphasizes the controllable and uncontrollable factors which influence the treatment outcome.

He analyses tardive complications and long-term results.

The author does comparative analyses of 2 periods:

The first period (1977-1990) was the period of mastering the art of different types of surgical interventions, accumulation of experience, the formation of principles of surgical tactics, elaboration and application of proper original surgical techniques;

The second period (1991-2005) was the period when scientific work was based on approved tactical and technical resolutions including prevention and early diagnosis of complications and their removal.

As the result, the author achieved the decrease of common lethality from 16.6% in the first period till 10.2% in the second period and diminution of complication’s frequency from 61.9% till 35, 7% correspondingly.