Lateral deviation esophagostomy. New simplified technical procedure
Pinotti, H.W.; Ellenborgen, G.; Rodrígues, J.J.; Zilberstein, B.; Raia, A.
Acta Gastroenterologica Latinoamericana 12(2): 135-141
1982
ISSN/ISBN: 0300-9033 PMID: 7158241 Document Number: 192014
A new technique of esophagostomy which ties in the endoscopic method to the surgical approach of the cervical region is presented. A Chevalier-Jackson 8 .times. 45 rigid esophagoscope is used; its distal extremity guides the surgeon in performing the incision in the left cervical region and underlying esophagus through which the grasping endoscopic forceps (which brings the Folley type no. 22 probe to the lumen of the esophagus) is exteriorized. Patients (28) were operated on, 9 with obstruction of the esophagus due to advanced neoplasia and 19 to rupture or perforation of the esophagus. A gastrostomy was performed at the same time with the esophagostomy in the patients who did not have it. There was no morbidity or mortality attributed to the surgery. In the patients with non-neoplastic esophageal fistula, the esophagostomy probe was withdrawn 3 wk-5 mo. after surgery when the fistulas were closed and there was a good healing of the esophagostomy orifice and no stenosis of the esophagus at this level. In the female patient with perforation of the upper thoracic esophagus, the deviation was not enough because the Folley probe balloon remained below the esophageal perforation. In 8 out of the 9 patients with obstruction of the esophagus by neoplastic process, esophagostomy also fulfilled its purposes. The 9th patient died 48 h after undergoing esophagostomy due to a serious pulmonary complication which he had before the surgery. Lateral deviation esophagostomy, described here, represents an important progress concerning the preservation of the esophageal anatomy since it permits the reconstitution of its continuity and function with the simple withdrawal of the Folley's probe.