Braghetto Italo, Cardemil Gonzalo, Csendes Attila, Venturelli Aliro, Herrera Mauricio, Korn Owen, Sepúlveda Sergio, Rojas Jorge
Department of Surgery, Faculty of Medicine, University of Chile, Santiago, Chile.
Arq Bras Cir Dig. 2013 Jan-Mar;26(1):7-12. doi: 10.1590/s0102-67202013000100003.
Severe dysphagia or even aphagia can occur after esophagectomy secondary to necrosis of the ascended organ with severe stricture or complete separation of the stumps. Catastrophic esophageal or gastric disruption drives the decision to "disconnect" the esophagus in order to prevent severe septic complications. The operations employed to re-establish esophageal discontinuity are not standardized and reoperations for re-establishment of the upper digestive transit are a real challenge.
This is retrospective study collecting the authors experience during 17 years including 18 patients, 14 of them previously submitted to esophagectomy and four to esophagogastrectomy. They were operated on in order to re-establish the upper digestive tract.
Redo esophago-gastro-anastomosis was possible in 12 patients, 10 through cervical approach and combined with sternotomy in four in order to perform the new anastomosis. In five patients a new esophago-colo anastomosis was performed. Free jejunal graft interposition was performed in one patient. Complications occurred in ten patients (55.5 %): anastomotic leaks in three, strictures in four, sternal condritis in two and cervical abscess in one. No mortality was observed.
There are different surgical options for the treatment of this difficult and risky clinical situation which must be treated with tailored procedures according to the anatomic segment available to be used, choosing the most conservative procedure.
食管切除术后，由于高位器官坏死伴严重狭窄或残端完全分离，可能会发生严重吞咽困难甚至吞咽不能。灾难性的食管或胃破裂促使医生决定“切断”食管，以防止严重的脓毒症并发症。用于重建食管连续性的手术并不规范，再次手术重建上消化道是一项真正的挑战。
这是一项回顾性研究，收集了作者17年间的经验，包括18例患者，其中14例曾接受食管切除术，4例接受食管胃切除术。他们接受手术以重建上消化道。
12例患者可行再次食管胃吻合术，10例经颈部入路，4例联合胸骨切开术以进行新的吻合。5例患者进行了新的食管结肠吻合术。1例患者采用游离空肠移植术。10例患者（55.5%）出现并发症：3例吻合口漏，4例狭窄，2例胸骨骨髓炎，1例颈部脓肿。未观察到死亡病例。
对于这种困难且危险的临床情况，有不同的手术选择，必须根据可用的解剖节段采用定制的手术方法进行治疗，选择最保守的手术。
