[Complications of esophageal reconstruction].

Esophageal cancer is the most common cause of esophageal resections. Esophageal replacement is still a significant challenge for surgeons, because complications can be expected in over 50% and death also occurs between 4-7%. Complications can be divided into early and late categories and into general and specific complications.

Dysphagia After Esophageal Replacement and Its Treatment.

Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the quality of life, can lead to a deterioration of the general condition, which may lead to death if left untreated. For this reason, their early detection and treatment are a matter of importance.

[Changes in surgical principles as a result of modern, effective, perioperative treatments].

Oncology has evolved to a great extent over the last quarter of century. The significant success is multifactorial, including primary and secondary prevention, the development of diagnostics, new methods of chemo-and radiotherapy, and the integration of basic research results into practice. From the point of view of surgery, the establishing and widespread practical application of the principles of preoperative oncotherapy played a major role in this development.

A comparison of pre-operative nutritional status with post-operative morbidity and mortality in obese esophageal surgery patients.

Objectives: The nutrition state of obese patients scheduled to undergo esophageal surgery was evaluated using two nutritional score systems: the mini nutritional assessment (MNA) and the prognostic and nutritional index (PINI). A further comparison of various proteins, lymphocytes and cholesterol was performed using biochemical tests. These factors were compared with post-operative morbidity and mortality in a prospective, descriptive clinical study.

[Experiences with central pancreatectomy].

Introduction: The authors report their experience with central pancreatectomy and also summarize relevant literature data.

Material And Methods: Central pancreatectomies were performed in 7 patients for benign or low-grade malignant pancreatic neoplasms, or pancreatic rupture in one patient. Most frequently applied anastomosis was between the distal part of the pancreas and a Roux-en-Y limb, while the proximal cut surface was closed with sutures, and the suture line was covered with a limb.

[Reconstruction of the esophagus with plastic surgery techniques].

Introduction: Various plastic surgery techniques were applied for oesophageal reconstruction in complicated cases. Myocutaneous flaps that are suitable to cover soft tissue defects of the neck may also be transferred and used for partial defects of the cervical oesophagus or securing a vulnerable suture line. Application of microsurgical techniques may also be useful in certain situations.

[The role of neoadjuvant therapy in the treatment of locally advanced squamous cell cancer of the cervical oesophagus].

Introduction: Cervical oesophagus represents a critical location for squamous cell carcinoma, which usually requires extensive surgery (pharyngo-laryngo-oesophagectomy). In the last decade, neoadjuvant chemo-radiotherapy was reported to be beneficial in the treatment of locally advanced squamous cell oesophageal cancer.

Methods: Between November 1997 and January 2012, 55 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy, where the tumour was localized in the upper third.

[Massive fundic gland polyposis caused by chronic proton pump inhibitor therapy].

We report two cases of a massive fundic gland polyposis associated with protracted proton pump inhibitor (PPI) therapy. Both patients were females aged 51. On repeated endoscopy, the number of fundic gland polyps was increasing steeply, and they resulted in a passage disorder.

Middle segmental pancreatic resection--a single-centre experience.

Background/aims: A single-centre experience gained by middle segmental pancreatic resection and a brief survey of technique and indications are reported.

Methodology: During the past 7 years 7 middle segmental pancreatic resections were performed for benign and low-grade malignant pancreatic lesions and in 1 case for pancreatic trauma. The preferred method was anastomosing the distal remnant to a Roux-en-Y limb, closure of the proximal cut end with sutures and in the last 4 patients covering this suture line with the limb.

[Colon cancer after colon interposition for oesophageal replacement].

The authors report the case of a colon adenocarcinoma developed on the neck at the anastomosis of the skin tube and colon 44 years following a corrosive oesophageal injury. This patient suffered a moderately severe oesophageal, stomach and laryngeal injuries due to drinking hydrochloric acid 44 years ago. He underwent serial laryngoplasties, then needed a tracheostomy, oesophagectomy, pyloroplasty and ileocolon transposition.

Unexpected insensitivity of the cholinergic motor responses to morphine in the human small intestine.

Background/aims: morphine is known to inhibit cholinergic contractions of the guinea pig small intestine. This has been compared to the human small intestinal innervated longitudinal muscle in the current study.

Methods: cholinergic primary contractions of human small intestinal longitudinal strips were evoked by electrical field stimulation (EFS; 0.

Chemo-radiotherapy in locally advanced squamous cell oesophageal cancer--are upper third tumours more responsive?

Before neoadjuvant therapy was widely applied, the prognosis of oesophageal cancer had been considered dependent on the location of the tumor, i.e. upper third cancers had had the worst prognosis.

The NANC relaxation of the human ileal longitudinal and circular muscles is inhibited by MRS 2179, a P2 purinoceptor antagonist.

Aims: Functional innervation of the human small intestine may be different from that of experimental animals. These experiments set out to assess the mediating roles of P(2) purinoceptors in the non-adrenergic, non-cholinergic (NANC) relaxation of the human ileum longitudinal and circular muscles.

Main Methods: In organ bath experiments NANC relaxations were evoked by electrical field stimulation (EFS).

Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count?

Background: Total gastrectomy results in a significant weight loss, different postgastrectomy symptoms, and a reduction in quality of life. Elaborate surgical reconstruction methods are evaluated to improve results. The present study compares two types of reconstructions--an aboral pouch with preserved duodenal passage and an oral pouch with preserved duodenal passage--differing only in the site of the pouch.

Effect of laparoscopic fundoplication on hypertensive lower esophageal sphincter associated with gastroesophageal reflux.

For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed.

[Surgical treatment of duodeno-gastro-esophageal reflux disease: duodenal switch].

Aims: To evaluate the efficacy of duodenal switch operation for patients with duodeno-gastroesophageal reflux disease.

Methods: Four female patients with therapy resistant epigastric pain and biliary regurgitation were enrolled in the study. In all cases, abnormal duodeno-gastric reflux was confirmed by 24-hour Bilitec monitoring.

[The effect of preoperative chemo-radiotherapy in the treatment of locally advanced squamous cell carcinoma in the upper- and middle-thirds of the esophagus].

Aim: The aim of this study was to compare the efficiency of the preoperative combined chemo-radiotherapy in the treatment of locally advanced squamous cell carcinoma in different locations of the oesophagus.

Methods: Between 1997 and 2005, 102 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases, the tumour was localised in the upper-third (Group I), while in 62 cases, in the middle-third of the oesophagus (Group II).

Prognostic factors in the surgical treatment of gastric cancer--10 years experience.

Background: In spite of the increase in radicality and extended resections, the prognosis of gastric cancer is very poor. Surgical resection is the only effective therapy. The morbidity and mortality of surgical interventions decreased during the last years.

[Esophagus replacement with anisoperistaltic left colon after removal of skin tube cancer].

Authors replaced the esophagus with anisoperistaltic left colon because they had no other possibilities. In this case twenty-one years ago after an esophageal injury the patient underwent gastric resection, removal of the esophagus and replacement with a skin tube created from a myocutaneous flap. Unfortunately the right colon earlier had been removed after an unsuccessful replacement.

[Progress in the treatment of gastrointestinal cancers due to introduction of neoadjuvant concept].

Formerly the treatment of gastrointestinal cancers was exclusively surgical. Though the results were improved by increased radicality, the real progress was achieved by the introduction of multimodal therapy, particularly by the neoadjuvant concept. The basic prerequisite for neoadjuvant treatment is precise staging and risk assessment.

[Peritonectomy and intraperitoneal chemotherapy in the treatment of peritoneal carcinosis].

The surgery of metastatic gastrointestinal malignancies comes into prominence nowadays. Positive observations inspire the increase of surgical radicality. Occurrence of peritoneal carcinosis means a very bad prognosis.

[Reconstruction after emergency esophageal and gastric surgery for corrosive injury].

We performed 26 reconstructions after emergency esophago-gastrectomy for corrosive injury during 13 years (1992-2004). Substernal replacement with pedicled colon graft was performed in 22 patients. Multi-stage operations were performed in 4 patients, two free jejunal grafts were applied after unsuccessful colon replacement.

[New laparoscopic procedure for the treatment of large hiatal hernias: the first 20 cases].

Aims: To evaluate the effect of a new laparoscopic procedure, which was developed in our institute for reinforcement of posterior hiatoplasty.

Methods: The results of our first 20 patients of this ongoing prospective study are presented. All patients had gastro-oesophageal reflux disease and a hiatus defect greater than 6 cm.

Esophagus reconstruction with free jejunal transfer.

Following pharyngolaryngectomy, reconstruction is one of the most challenging surgical procedures. Here we review our own experiences using a microvascularly transferred free jejunal graft. This method was performed in 22 patients (19 male and 3 female, aged 40-63 years).

[Resectable esophageal metastasis of stomach cancer].

The appearance of distant metastases meant in the past, that gastric cancer was incurable. However, experience with colorectal cancer has shown that patients with distant metastasis may have a chance for cure, if metastatic disease can be completely resected. Considering these experiences in the literature it seems that the judgement of gastric cancer has recently changed.