Creating artificial esophagus

The creation of artificial esophagus (esophagoplasty) is held in the complete loss of natural functions of the esophagus or in the absence thereof. The main evidence - cicatricial stenosis P. (often after burns), is not available or cannot be birovni forced to nutrition through a gastrostomy tube. Less often esophagoplasty produce after resection P. cancer him when the patient recovers and strengthen, eating after gastric fistula. Sometimes esophagoplasty used for newdecimal tumor P. instead gastrostomy.
Artificial esophagus can be created of leather, made in the tube epidermis inside; from skin pipes and parts of the stomach wall; from skin tube and loops of small bowel; only from the gut (thin or thick). Finally, thoracic vertebrae P. you can replace the stomach, moved into the chest cavity (Fig. 58). Often used intestinal transplants: P. of them perform better than the esophagus of the skin; in addition, this Isthmus you can place not only intestinale (under the skin), but retrosternal (mediastinum), which is beneficial in terms of functionality and more convenient for the patient (Fig. 59).

Fig. 58. Scheme of operations the creation of artificial esophagus: 1 - from skin tube; 2 - from the transverse colon; 3 - the replacement of the esophagus moved into the chest cavity stomach; 4 - from skin tube and flap gastric wall; 5 - from skin tubes and small intestine; 6 - from the small intestine.
Fig. 59. Artificial esophagus from the small intestine: 1 - chest; 2 - subcutaneous.

The risk of bowel necrosis and the difficulty of removing it high on the neck was overcome by improving the methodology of Ru and P. A. Herzen. At the Institute. Sklifosovsky S. S. Yudin, B. A. Petrov, G. P. Khundadze, since 1956.. as a rule, the operation of creating artificial P. from the intestine finished within a week. This method is almost completely replaced esophagoplasty of the skin of the tube. The move operation of the stomach into the chest cavity apply mainly simultaneously with resection of the esophagus cancer.
Preparing to the plastic P. intestinal loop consists of activities restorative nature. Impose gastric fistula through which feed the sick, giving high-calorie, rich in protein and vitamins food. Again, blood transfusions, plasma, administered parenteral protein hydrolysates, solutions of glucose and salt, physiological. If there are plastic from the colon, then three days before the operation is prescribed "this template shall not" diet. Before the operation the intestines thoroughly cleanse laxative and repeated enemas, enter through a gastrostomy tube kolimitsin, monomitsin, neomycin.