The described imaging findings reveal high diagnostic significance in the differentiation of benign strictures from esophageal cancer.

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Несмотря на непрерывное совершенствование методов лечения рака желудка, его рецидивы по-прежнему остаются основной причиной смерти радикально оперированных больных. Цель исследования-создание концепции физиологической реконструкции в хирургии рецидива рака желудка. Материал и методы. В период с 2012 по 2017 г. в НМИЦХ им. А.В. Вишневского выполнено 25 операций по поводу рецидива рака желудка. В исследуемой группе было 15 (60%) мужчин и 10 (40%) женщин, средний возраст составил 58 лет. Рецидив опухоли локализовался в зоне анастомоза у 11 (44%) пациентов, рецидив рака в культе выявлен у 8 (32%), регионарный рецидив с ростом опухоли в ложе удаленного желудка (в лимфатических узлах) наблюдали у 3 (12%) больных. Повторные операции были выполнены всем 25 пациентам. Экстирпацию культи желудка выполнили 8 (32%) пациентам, из них еюногастропластику (ЕГП)-4, реконструкцию по Ру-4. Резекцию отводящей петли с реконструкцией по Ру произвели 1 (4,0%), после резекции эзофагоеюноанастомоза (ЭЕА) выполнили ЕГП-1. После резекции эзофагогастроанастомоза 5 пациентам осуществили ЕГП по типу операции Меrendino-Dillard. После эзофагэктомии в качестве пластического материала в 8 (32%) наблюдениях использовали левую половину ободочной кишки, в 1-поперечно-ободочную кишку в антиперистальтическом положении + ЕГП. В 1 наблюдении реконструкцию не завершили. Результаты. Хирургическое лечение в объеме R0 выполнено 24 (96%) больным, в объеме R1-1 (4%) больной, R2-0. В раннем послеоперационном периоде осложнения выявлены у 3 (12%) пациентов: у 1 (4%) частичная несостоятельность ЭЕА и у 1 нагноение послеоперационной раны. Все они разрешились консервативно. Лишь 1 (4%) больному потребовалась релапаротомия на 9-е сутки ввиду некроза толстокишечного трансплантата, который резецировали с выведением питательной коло-и эзофагостомы. Летальных исходов не было. В отдаленном периоде под наблюдением находились 20 (80%) из 25 пациентов. Осмотр пациентов выявил хороший функциональный результат у 9 (45%) из них, удовлетворительный у 6 (30%). Повторная операция не принесла облегчения 5 (25%) больным. Медиана выживаемости составила 3 года. Выводы. Оценка полученных результатов демонстрирует значительное ослабление патологических синдромов оперированного желудка. Этот факт говорит о целесообразности повторных операций на желудке с его пластическим замещением и восстановлением дуоденального пассажа пищи.

Immediate results did not significantly differ in the both groups. Blood loss was 528±61.0 and 507±71.2 ml, incidence of complications--20.0 and 6.7%, frequency of esophagostomy failure--3.3% and 0, postoperative mortality rate--3.3% and 0, duration of postoperative hospital-stay--12.4±1.3 and 10.9±1.2 days respectively (p<0.05). In remote postoperative period the number of patients with stable body mass index or its positive changes was 52.9 and 81.8% in control and main groups, with dumping syndrome--47.1 and 9.1%, with diarrhea--35.3 and 4.5% respectively (p<0.05). Index of good state of health in main group was 68.2%, in control group--17.6% (p<0.05). In authors' opinion safety and physiological efficiency of jejunogastroplasty allow you considering its priority for primary reconstruction after gastrectomy and alternativeness to Roux-en-Y technique.

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Objective. The compensation of digestive disorder in patients who already had gastric operation by using jejuno(colo)gastroplasty at re-reconstruction of the digestive tract.Methods. During 2012-17 in Vishnevsky surgery institute 33 repeated operation were conducted on the patients who had already had resection and antireflux gastric operations. As a repeated operation was conducted jejunogastroplasty in 31 (93,9%) cases, after distal gastrectomy - 8 (24,3%) from them; after gastric stump removal - 7 (21,2%), after еsophagojejuno anastomosis resection - в 2 (6,1%). Also 3 (9,1%) patients were operated on using interposition of the discharge loop into the duodenum: 2 - after gastrectomy with Braun and Roux-en-Y и 1 - after Distal gastrectomy, Hoffmeister. Esophagogastro anastomosis resection; jejunogastroplasty in Merendino-Dillard were conducted on 11 (33,3%) patients. A segment of transverse colon as a plastic material was used on 2 (6,1%) patients: у 1 - after gastric stump removal, у 1 - after еsophagojejuno anastomosis resection.Results. In the early postoperative period 2 (6,1%) patients had surgical complications: one had Partial esophagojejunо anastomosis leakage, the other - under diaphragmatic abscess. One fatal case from progressing multiple organ failure was recorded in the first 24 hours. By the end of the research 28 (84,8%) of 33 patients stayed under the surveillance. The examining of the patients revealed good results after the operation of 21 (75,0%) patients and satisfactory results after the operation of 7 (25,0%) patients. Conclusion. We believe that principles proposed of physiological reconstruction of the digestive tract are universal for primary gastric interventions as well as for repeated ones. It is worth noting that the repeated operations don’t always fully remove clinical manifestations diseases of the operated stomach but significantly decrease their severity by strengthening the patients physically by restoration of physiological passage of food and the expansion of the nutrition.

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The perioperative enhanced recovery protocol routinely uses in esophageal surgery. It acquired new aspects which were adapted to reduce the rate of morbidity and mortality. Esophagectomy still remains a high-risk operation, which carries out in high-volume centers on patients with significant comorbidities. It challenges the multidisciplinary team to personalize approach to create a safe recovery after surgery. The objective of the study is to show the aspects of evolution of the protocol after esophageal surgery. A total 393 patients with benign and malignant esophageal diseases underwent esophagectomy with simultaneous reconstruction between December 2012 and December 2021. The median age was 59 years (47;67), females were 39,7% and males—60,3%. The prevalence of the patient with nutritional deficiency was 20% (BIM &lt; 18.5) and ASA score III-IV—66,9%. The tranthoracic and transhiatal esophagectomy were used for 42,2% and 57,8% of patients with the reconstruction by gastric pull up (92,1%), colon conduit (6,4%), jejunal loop interpostion with gastric pull-up 1% and with colon conduit 0,5%. 169 patients (43%) had postoperative complications, while 28,9% of them had one complication and 3,6% more than 4 complications at the same time. The prevalence of complications: pneumonia—8,2%, atrial dysrhythmia requiring intervention—7,7%, pulmonary embolism—1%, acute renal failure requiring dialysis—1,5%. The anastomotic leak occured in 5,4% patients and conduit necrosis—in 2,8% (2,3% extensive) patients. The prevalence of patients required repeated surgery was 6,4%. The rate of severe complications (&gt;IIIb- Clavien-Dindo) was 14,4%. Median postoperative day was 9 (8;11). The postoperative mortality rate 1,8%. The aspects of the perioperative enhanced recovery protocol were modified to complicated surgery with simultaneous resection of other organs, esophagogastrectomy or reconstruction by combined conduit with jejunal loop with early oral feeding and rapid recovery. The decade-long experience of the evolution of the perioperative enhanced recovery protocol has led to the development of the personalized approach to the patients with significant comorbidities that allowed reducing the incidence of postoperative complications and mortality after esophagectomy.