RÒ MIỆNG NỐI SAU PHẪU THUẬT NỘI SOI CẮT THỰC QUẢN, TẠO HÌNH THỰC QUẢN BẰNG TOÀN BỘ DẠ DÀY CÓ NONG MÔN VỊ TRƯỚC MỔ ĐIỀU TRỊ UNG THƯ BIỂU MÔ VẢY THỰC QUẢN

Abstract

Objectives: Analysis of risk factors for postoperative anastomosis leak anastomotic in a group of patients undergoing laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation for esophageal squamous cell carcinoma. Subjects and methods: A retrospective descriptive study on 28 patients undergoing laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation at Ha Noi Medical University and Viet Duc Medical University from January 2020 to March 2023. Results: We performed laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation for 37 patients. The mean age was 57.1 ± 8.68. All patients were male. The mean surgical time was 305.9 ± 46.95 minutes. The conversion rate to open abdominal surgery was 2 patients (5.4%), the rate of end-to-end anastomosis was 94.6%. The mean duration of mechanical ventilation was 32.3 ± 28.42 minutes, the time to remove the pleural drain was 9.1 ± 5.76 days, and the mean of hospital stay was 13.6 ± 6.28 days. Among 34 post-operative cases underwent gastric transit scans, most had non-dilated stomachs with efficient pyloric drug circulation (82.4%). The rate of anastomotic leakage in 2 patients (5.4%), pneumonia in 3 patients (8.1%), chylothorax in 4 patients (10.8%) and recurrent laryngeal nerve damage occurred in 10.8% of cases. In the 2 patients with anastomotic leakage, 1 patient had a history of cardiovascular disease. Both patients had preoperative normal nutritional status. After surgery, both cases showed signs of anastomotic stenosis. There was a patient who had esophageal dilation with a balloon and the other had esophageal stent. Conclusion: laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon is safe and feasible with a low rate of anastomotic leakage and other complications. However, this is a difficult technique, requiring the surgeon to have a lot of experience and adequate equipment and instruments.