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Reconstruction of the oesophagus by Howard's method
ABSTRACTS
451
versus teflon-impregnated polyester fiber in esophageal anastomosis. The catgut suture had 2.8 times greater chance of not leaking. Between 1957 and 1971, 50 neonates with tracheoesophageal fist& and esophageal atresia were repaired with a retropleural division of the fistula and an end-to-end single-layer 4-0 chromic catgut anastomosis. There were only three leaks, all of which closed “nonoperatively.” No dilations were necessary in any of the 50 cases. -Edward 7. Berman Azygoplasty
as
Complementary
Surgical
Method in Treatment of Congenital Oesophageal Atresia. V. fuvezan, C. Veleanou, Chir.
C. Duica, and M. Scoliuc. Inf. 13:99-105, 1972.
Ann.
A new method to consolidate the anastomosis in congenital esophageal atresia is proposed. The arch of the azygos vein is used as a transplant to cover the anterior face of the esophagea1 anastomosis and thereby reduce the tension at the anastomotic site. If, for any reason, the azygos vein is not available, a segment of the umbilical or saphenous vein may also be used for this purpose. An experimental study on four dogs showed good results. The only two babies operated by the authors according to the reported method died from causes other than directly related to surgery.-C. Bretscher Reconstruction of the Oesophagus by Howard’s Method. M. Jaubert de Beaujeu, P. MO/lard, A. Campo-Paysaa, Y. Chavrier, 13:65-68,
and G. Kormaz. 1972.
Ann. Chir.
Inf.
Since 1967 the authors have treated 78 esophageal atresias. In 13 of them direct anastomosis was not feasibIe and therefore Howard’s method was used. Seven of the 13 were type I without fistula and the other had an inferior fistula. The latter was tied off before beginning with Howard’s procedure. The technique is described in detail: it consists of gastrostomy feeding, continuous aspiration, and instrumental elongation of the upper esophageal blind pouch. Radiographic studies showed an elongation of 2-3 cm in 3 mo. The procedure resulted in eight survivals and five deaths. None of the fatalities were consid-
ered to be due to the applied technique. Death was caused by prematurity and polymalformation (three), mediastinitis secondary to spontaneous perforation of upper esophageal segment before any elongation attempt (one), and anoxia (one). Among the eight surviving cases, five recovered, of whom two have had a secondary fistula; and in the three last cases Howard’s method was abandoned and coloplasty performed. The authors prefer Howard’s technique for the following reasons: (1) it bears fess risks than coloplasty at birth; (2) it takes less time and is less complex than late coloplasty; (3) it allows preservation of the esophagus: (4) it may be abandoned at any time in favor of late coloplasty.-C. Bretscher The Use of Colon for Oesophageal Replacement in Children. Lester W. Martin. Aust. New Zeal. J. Surg. 42:160-163 (November), 1972.
The author reviews his experience in replacing the esophagus with a portion of colon in 21 children approximately z yr of age, with atresia, stricture, or varices. When the lower portion of the esophagus was involved, it was replaced by an isoperistaltic segment of transverse colon to the cardia of the stomach and pyloroplasty with vagotomy were performed. When the entire esophagus was replaced, the right colon was used in a retrosternal, extrapleural position and in two instances, because of anomalous blood supply, an antiisoperistaltic arrangement was used with no problems occurring postoperatively. Recently, a cervical caecostomy just distal to the superior anastomosis has been added. The anastomosis to the stomach was as close to the fundus as possible and a gastrostomy and pyloroplasty were done routinely. There were two deaths: the first patient in the series suddenly died in the recovery room, and the other child died later due to polycystic kidneys. The major complications were related to upper anastomosis; four patients developed leaks that healed spontaneously and six patients developed strictures. Three of the latter strictures were asymptomatic and found only on esophagoscopy, but correction overcame a failure to gain weight. Long-term results were most gratifying, except for children
451
versus teflon-impregnated polyester fiber in esophageal anastomosis. The catgut suture had 2.8 times greater chance of not leaking. Between 1957 and 1971, 50 neonates with tracheoesophageal fist& and esophageal atresia were repaired with a retropleural division of the fistula and an end-to-end single-layer 4-0 chromic catgut anastomosis. There were only three leaks, all of which closed “nonoperatively.” No dilations were necessary in any of the 50 cases. -Edward 7. Berman Azygoplasty
as
Complementary
Surgical
Method in Treatment of Congenital Oesophageal Atresia. V. fuvezan, C. Veleanou, Chir.
C. Duica, and M. Scoliuc. Inf. 13:99-105, 1972.
Ann.
A new method to consolidate the anastomosis in congenital esophageal atresia is proposed. The arch of the azygos vein is used as a transplant to cover the anterior face of the esophagea1 anastomosis and thereby reduce the tension at the anastomotic site. If, for any reason, the azygos vein is not available, a segment of the umbilical or saphenous vein may also be used for this purpose. An experimental study on four dogs showed good results. The only two babies operated by the authors according to the reported method died from causes other than directly related to surgery.-C. Bretscher Reconstruction of the Oesophagus by Howard’s Method. M. Jaubert de Beaujeu, P. MO/lard, A. Campo-Paysaa, Y. Chavrier, 13:65-68,
and G. Kormaz. 1972.
Ann. Chir.
Inf.
Since 1967 the authors have treated 78 esophageal atresias. In 13 of them direct anastomosis was not feasibIe and therefore Howard’s method was used. Seven of the 13 were type I without fistula and the other had an inferior fistula. The latter was tied off before beginning with Howard’s procedure. The technique is described in detail: it consists of gastrostomy feeding, continuous aspiration, and instrumental elongation of the upper esophageal blind pouch. Radiographic studies showed an elongation of 2-3 cm in 3 mo. The procedure resulted in eight survivals and five deaths. None of the fatalities were consid-
ered to be due to the applied technique. Death was caused by prematurity and polymalformation (three), mediastinitis secondary to spontaneous perforation of upper esophageal segment before any elongation attempt (one), and anoxia (one). Among the eight surviving cases, five recovered, of whom two have had a secondary fistula; and in the three last cases Howard’s method was abandoned and coloplasty performed. The authors prefer Howard’s technique for the following reasons: (1) it bears fess risks than coloplasty at birth; (2) it takes less time and is less complex than late coloplasty; (3) it allows preservation of the esophagus: (4) it may be abandoned at any time in favor of late coloplasty.-C. Bretscher The Use of Colon for Oesophageal Replacement in Children. Lester W. Martin. Aust. New Zeal. J. Surg. 42:160-163 (November), 1972.
The author reviews his experience in replacing the esophagus with a portion of colon in 21 children approximately z yr of age, with atresia, stricture, or varices. When the lower portion of the esophagus was involved, it was replaced by an isoperistaltic segment of transverse colon to the cardia of the stomach and pyloroplasty with vagotomy were performed. When the entire esophagus was replaced, the right colon was used in a retrosternal, extrapleural position and in two instances, because of anomalous blood supply, an antiisoperistaltic arrangement was used with no problems occurring postoperatively. Recently, a cervical caecostomy just distal to the superior anastomosis has been added. The anastomosis to the stomach was as close to the fundus as possible and a gastrostomy and pyloroplasty were done routinely. There were two deaths: the first patient in the series suddenly died in the recovery room, and the other child died later due to polycystic kidneys. The major complications were related to upper anastomosis; four patients developed leaks that healed spontaneously and six patients developed strictures. Three of the latter strictures were asymptomatic and found only on esophagoscopy, but correction overcame a failure to gain weight. Long-term results were most gratifying, except for children