StatusThe thesis was presented on the 17 May, 2017
Approved by NCAA on the 31 May, 2017
Abstract– 2.53 Mb / in romanian
11.70 Mb /
The thesis includes introduction, six chapters, conclusions and practice recommendations. It is exposed over 290 of typed pages, contains 74 tables, 97 figures. References include 392 of sources. Results of the study were published in 61 articles. Study domain: surgical treatment of benign diseases of the gastroesophageal junction.
Goal of the study is improvement of the results of multimodal treatment in patients with benign diseases of GEJ by means of optimized diagnostics, implementation and refinement of surgical techniques based on the pathophysiological findings.
Objectives of the study. Assessment of the incidence and prevalence of the benign diseases of GEJ in the general structure of admissions in our department; implementation of new diagnostic methods for GEJ pathology (24-hours pH-metry, manometry HRM, esophageal scintigraphy) for determination of optimal surgical procedures in the treatment of benign diseases of GEJ; introduction in clinical practice of novel endoscopic methods (magnification, narrow band imaging, chomoendoscopy) as a part of preoperative examination; development of the diagnostic and treatment algorithm for patients with benign diseases of GEJ; improvement and wide implementation of minimally invasive techniques in treatment of the non-oncologic diseases of GEJ at early stages; comparative analysis of different treatment methods (medical, surgical, endoscopic) in patients with benign GEJ pathologies, using as end-points early and late postoperative results, social and professional reintegration and grade of patient’s satisfaction; development and implementation of alternative method of treatment of GEJ diseases based clinical study of effects of electrical stimulation on the LES function.
Scientific novelty. For the first time the benign pathology of GEJ was regarded as a separate clinical group of entities with common diagnostic and treatment strategies; for the first time the surgical procedure and the volume of intervention was selected in relation to the type of reflux, esophageal motility data and changes of esophageal mucosal layer; it was shown, that implementation of minimally invasive methods of treatment at the early stages of benign GEJ diseases improves the results of treatment; our morphometric and histologic scientifically argued different types of crurorhaphy; comparative analysis of two types of fundoplication (modified Lortat-Jacob anterior half-valve 270° and Nissen-Rosseti fundoplication) demonstrated necessity of differentiated curative attitude in different evolutive phases of GERD; a new model for clinical studies of electrical stimulation of LES was developed, that provide data about optimal parameters of LES electrical stimulation.
Scientific issues solved in this thesis. A new differentiated clinical strategy in benign GEJ diseases was developed throughthe implementation of new methods of diagnostic and treatment. Complex analysis of early and late postoperative results demonstrated high efficiency and safety of minimally invasive methods of treatment (laparoscopic, endoscopic) in patients with benign diseases of GEJ.
Practical value of the study.A modified fundoplication with anterior 270° half-valve was justified and used in clinical practice; an improved method of crurorhaphy was proposed; a new method of lead fixation for electrical stimulation of LES was developed and used in clinical study; a modified technique of esocardiomiotomy in esophageal achalasia was implemented in our department; the procedure of diverticulectomy in epiphrenic diverticulum was improved.