The basis for the use of colonic esophageal plasty is the need to create a transplant of great length. E. N. Vantsyan and R. A. Toshchakov (1971) showed that a colonic transplant is less sensitive to microcirculation and oxygenation disorders than a small intestine transplant. Morphological changes in the graft from the colon during its functioning as the esophagus are expressed in the proliferation of the goblet walls of the glands, the restructuring of the vessels of the submucosal layer. The entire segment of the large intestine, located between the caecum and the rectum, is designated by one common name - the colon.
The latter is divided into the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. According to F. Treves (1885), in men, the length of the large intestine is on average 136 cm, and in women - 132 cm. For the formation of an artificial esophagus, a section of the intestine 40-60 cm long is usually used.
The colon receives arterial branches from two vascular highways - the superior and inferior mesenteric arteries. The superior mesenteric artery sends the ileocolic, right colic, and middle colic arteries to the colon. The inferior mesenteric artery gives off the left colon and sigmoid arteries to the colon. Its terminal branch is the superior rectal artery. The largest anastomosis between the superior and inferior mesenteric arteries is the Riolan arc formed by the left branch of the middle colic artery and the ascending branch of the left colic artery.
The extraorganic veins of the colon are venous highways that usually accompany the arterial trunks of the same name and their branches, belonging to the system of the superior and inferior mesenteric veins and draining blood into the portal vein. When forming an artificial esophagus, it is necessary to take into account the structural features of both the arterial and venous systems in each specific case, since the viability of the graft depends entirely on individual features vessels of the mesentery [Shalimov A. A. et al., 1975].
To create an artificial esophagus, the right or left half of the colon can be used, which is located in the iso- and anti-peristaltic direction (see figure below).
a-places of ligation and intersection of vessels during plasty with the right half of the colon (1) with the transverse colon (2 and 3), with the left half of the colon, (4); b - according to Lafargue; in-transverse colon; d – according to Scanlon and Steili, e – according to Shalimov. Scheme.
"Burns of the esophagus and their consequences",
G.L. Ratner, V.I. Belokonev
a) Indications for plastic surgery of the esophagus with the large intestine behind the sternum. Placement of the colon behind the sternum for reconstruction or esophageal bypass is very rarely used. The large intestine can be located substernally if the patient has already had the esophagus removed, but its reconstruction has failed. In this situation, it may be necessary to place the graft away from the original esophageal bed.
In rare cases in esophageal cancer palliative surgery without esophagectomy is preferred. Patients with tracheoesophageal fistulas are usually incurable. Attempts to remove the esophagus almost always pose an inevitable problem for the surgeon to repair a defect in the trachea or bronchus.
Besides, palliative surgery without removal of the esophagus, it is also indicated for patients without tracheoesophageal fistulas, who have undoubted signs of a malignant tumor growing into the trachea, detected during bronchoscopy. In such patients, there may be complete obstruction of the esophagus by a tumor, and in the presence of a tracheoesophageal fistula, repeated aspiration of food masses with the development of pneumonia.
They can perform palliative surgery- esophageal bypass with a part of the large intestine placed behind the sternum. This operation eliminates dysphagia and allows the patient to eat and drink.
b) Technique and stages of reconstruction of the esophagus with the large intestine behind the sternum. Patients undergoing esophageal bypass surgery are laid supine on the operating table, they are treated and the front surface of the chest and abdomen is covered with sterile linen. The patient's head is turned to the right. Perform a wide median laparotomy. A long graft is prepared from a segment of the colon to serve as an esophageal bypass.
The graft contains most transverse colon, the splenic angle and a large section of the descending colon, supplied by blood from a common tributary - the ascending branch of the left colonic artery. The omentum is separated from the transverse colon, the left half of the large intestine is mobilized from the retroperitoneal space. The surgeon can calculate the points of intersection of the right half of the transverse and descending colon and then measure the length of the colonic graft with an umbilical tape.
Calculate adequate length of the colon: The graft should reach the neck with some excess. Graft viability, as determined by blood flow in the ascending branch of the left colonic artery, can be tested by applying a bulldog clamp to the base of the median colonic artery and the marginal artery proximal and distal to the intended colonic intersections. After the surgeon is convinced of the viability of the graft, he crosses between the two clamps the marginal arteries at its ends.
Besides, ligates and crosses middle colic artery proximal to its bifurcation. The mesentery of the transverse colon is dissected up to the ascending branch of the left colonic artery.
Mobilization of the graft from the long segment of the colon is completed by the release of the splenic angle. After that, the colon is divided proximally and distally using a linear stapler.
If the patient has not previously used neck access, a curvilinear incision is made, starting 1 cm above the jugular notch of the sternum and continuing to the left, above the middle part of the sternocleidomastoid muscle. In cosmetic terms, it is more advantageous than an incision along the anterior edge of the sternocleidomastoid muscle. The subcutaneous muscle of the neck is dissected, its edges are separated along the periphery of the incision to a depth of about 1 cm. The scapular-hyoid muscle (m. omochyoideus) and the middle thyroid vein are crossed.
Retractor retract trachea and thyroid gland medially, and the sternocleidomastoid muscle - laterally, being careful not to overstretch the recurrent laryngeal nerve or carotid sheath. The esophagus with a probe inserted into it is easy to detect by palpation. The esophagus is dissected circumferentially and grasped with a Babcock forceps. The esophagus should be dissected carefully so as not to damage the recurrent laryngeal nerves. A small Penrose drain is used to circumscribe the cervical esophagus.
If the patient has already developed esophagostomy, it is isolated from the surrounding tissues and the edges of the previous wound on the neck are bred. The dissection is carried out deep into the prevertebral fascia.
After that create a substernal tunnel. Below, after excision of the xiphoid process, the surgeon easily penetrates into the space along the edge of the periosteum of the posterior surface of the sternum. This space is filled only with loose fiber, therefore a tunnel can be created in it, rising from the bottom up, along the periosteum of the posterior surface of the sternum. Perforation of the pleura, as a rule, does not occur. If the left sternoclavicular junction protrudes too much, it may need to be cut with bone cutters or a Lebske knife so that it does not compress the colonic graft.
After the channel is made, to the proximal end of the graft, a 32 Fr thoracic drainage tube is fixed with single sutures with No. 2/0 silk. This will facilitate the passage of a long segment of the colon through the substernal space. Thoracic drainage is carried out from below in the retrosternal space and captured from above. The graft, fixed to the drainage tube, is then carefully pulled over the neck. When pulling up the colonic graft, it should pass behind the stomach. Thus, subsequently, the feeding vascular pedicle of the graft lies behind the stomach.
Difficulties in formation of a graft of adequate length should not be. The esophagus is transected with a linear stapler just above the upper thoracic inlet. The colon should lie comfortably in the wound on the neck, after which end-to-end esophagocoloanastomosis is applied without tension. The anastomosis is created with two rows of single interrupted sutures with silk No. 3/0. The outer row of sutures along the posterior surface of the anastomosis is created before opening the lumen of the esophagus. The staple lines are removed from both the esophagus and the intestine. An internal row of sutures is applied along the posterior surface of the anastomosis, silk ligatures No. 3/0 are passed through the walls of the esophagus and colon.
Before proceeding to the seams on anterior wall of the anastomosis, advance the nasogastric tube from the esophagus into the intestine. Later, its end will be in the stomach. The inner row of separate interrupted sutures along the anterior wall of the anastomosis is made with silk No. 3/0, sticking the needle from the inside outward on the intestine and from the outside inward on the esophagus. The outer row along the anterior wall of the anastomosis is represented by a series of Lambert sutures made of silk No. 3/0.
Next stage operations- Cologastrostomy along the posterior surface of the body of the stomach. Before proceeding with the imposition of the distal anastomosis, it is necessary to excise the excess length of the colonic graft. Between it and the stomach, a standard fistula is applied with two-row sutures: the outer row is made of single interrupted sutures, the inner one is a continuous suture. First, an outer row of sutures is created along the posterior wall of the anastomosis (Lambert sutures, single nodal silk No. 3/0).
Electroknife a line of staples is excised on the colon and a hole is formed on the stomach. An internal continuous sealing suture along the posterior wall of the anastomosis is made with a synthetic absorbable thread No. 3/0.
It is continued like an inseam along the anterior wall of the anastomosis according to the Connell method. Before closing the inner suture of the anterior wall of the anastomosis, the nasogastric tube is advanced from the distal colon graft into the stomach. Cologastrostomy is completed by applying the outer row of Lambert sutures along the anterior wall with silk No. 3/0. The completed shunt passes through chest behind the sternum and behind the stomach abdominal cavity.
Colon integrity restored by bellostomy. The right half of the transverse colon and the distal part of the descending colon are connected by a standard two-row anastomosis. As a rule, the latter can be applied above the root of the mesentery of the colon, provided that the right half of the colon is isolated from the retroperitoneal space and the sigmoid colon is mobilized. If the ends of the intestine cannot be brought together without tension, then it is necessary to conduct an extended mobilization of the ascending colon and turn it down, after which an anastomosis should be made below the root of the mesentery of the small intestine.
There are several options for conducting a shunt behind the sternum and turning it off thoracic esophagus. If he remained in his usual place and was turned off from the passage of food, it is possible (although very rarely) that its isolated segment between the neck and the obturating tumor will break through along the proximal line of the brackets and mediastinitis will develop. Based on these considerations, a narrow catheter can be passed into the proximal esophagus through a purse-string suture (silk No. 3/0). The catheter is brought to the neck and left to decompress the esophagus.
The surgeon may also bandage the transition site. esophagus into the stomach with a piece of umbilical band, which is especially important in the presence of an esophageal-tracheal fistula. Such a maneuver prevents reflux of gastric contents into the proximal esophagus, which is fraught with food entering the pulmonary tree through the tracheoesophageal fistula. If the surgeon performs a ligation of the esophageal-gastric junction, he must separate the vagus nerves from the esophagus and keep them, and pass the tape under them.
The position of the patient, skin treatment, isolation of the surgical field, placement of the participants in the operation are the same as with. Before starting the operation, it is necessary to suck the contents of the stomach through the gastrostomy tube using an electric suction. After that, the tube is removed, and the gastric fistula is tightly sealed with a sterile gauze plug. Only after carrying out these preparatory measures, they begin to process the surgical field and isolate with sterile sheets.
2. Graft formation. All loops of the small intestine are displaced to the left. To hold them in this position, the sister gives a sheet or towel. The surgeon lifts the dome of the caecum with a Luer clamp and cuts the posterior peritoneum to the hepatic angle with long scissors. The thick and terminal ileum are isolated with long tupfers on forceps. During the operation, small vessels are ligated with catgut. Having selected the graft, the surgeon brings it into the wound and, using a portable light, shines through the mesentery to study its vessels. If the surgeon decides that the graft is suitable for plasty, proceed to its final mobilization.
A Hepfner clamp is temporarily applied to the isolated iliococolic artery while the appendectomy is performed. If during this time there are no signs of graft circulatory disorders, the vessel is crossed between two clamps and both ends are tied with a silk ligature.
For transection of the ileum, the nurse provides two intestinal clamps and napkins to isolate the surgical field. The abdominal scalpel, after crossing the intestine, is dropped into the pelvis. The proximal part of the crossed intestine is wrapped with a napkin without removing the clamp. The distal end of the ileum is sutured with a continuous catgut suture, and then it is immersed inside with a silk purse-string suture. The thread for the purse-string suture must be prepared long, since later it will be used to carry out the graft on the neck.
This completes the graft preparation. The surgeon tries on its length with a thick thread; if the end of the ileum reaches the thyroid cartilage, the graft is placed in the abdominal cavity.
3. Preparation of the retrosternal tunnel. With a sharp hook, the assistants lift the costal arch. The surgeon with a scalpel crosses the attachment of the diaphragm posterior to the xiphoid process and forms a retrosternal tunnel from below with fingers and tupfers. For this stage of work, the sister should provide good illumination from below with a portable lamp. As you move up, you need to give the assistants longer hooks to hold the anterior chest wall in an elevated position. Periodically, the surgeon needs long scissors to cut individual strands.
The upper part of the channel is formed from the side of the neck. For this, a skin incision is made along the inner edge of the sternocleidomastoid muscle to the left upwards from the jugular notch. Here, the channel is also formed mainly with blunt instruments (tupfers) or fingers. If necessary, ligate the vessel, long ligatures should be applied, since the ligation is performed in the depth of the wound. To connect the lower and upper parts of the retrosternal canal, a small (narrow) Yudin dilator is inserted into it from below, and a finger from above. By replacing the dilators with wider ones and moving them upwards, the formation of the tunnel is completed and it is tamponed loosely with napkins.
4. Carrying out a transplant on a neck. The sister gives Yudin's narrow dilator with a hole at the end, and the surgeon leads it into the canal from the side of the neck, having previously threaded a thick silk ligature into the hole. From the side of the abdominal cavity, a thread left on the distal ileum stump is tied to this ligature, and the graft is pulled through the tunnel.
5. Imposition of gastroanastomosis. The transverse colon is transected between two Payr's forceps. Between the leading end of the transverse colon and the anterior wall of the stomach, an end-to-side anastomosis is performed with two-row continuous catgut and interrupted silk sutures. At this stage, the nurse must ensure that the other end of the transected transverse colon is carefully wrapped in several layers of gauze so that it does not infect the surgical field.
6. Imposition of ileotransverse anastomosis. The inter-intestinal anastomosis during this operation can be applied both end-to-end and end-to-side. This concludes the first stage of the operation. A thorough revision and toilet are carried out and the laparotomy wound is sutured.
7. Imposition of an anastomosis between the esophagus and the graft. Usually this stage of the operation is performed after 6-8 days, however, sometimes the entire operation is performed in one day. A roller is placed under the patient's shoulder blades, and the head is turned to the right. The edges of the skin wound are bred by removing the sutures. The graft is freed from loose adhesions and taken to the lower corner of the wound. The nurse sees to it that the assistants use the Farabeus hooks, and not the pointed hooks, to retract the sternocleidomastoid muscle along with the neurovascular bundle. To lead to the midline of the left lobe of the thyroid gland, it is stitched with a thick catgut thread (catgut No. 6, 45 cm long). After the removal of the gland, an olive or a thick bougie is introduced into the esophagus, which helps to better isolate the esophagus and detect the localization of its stricture in esophageal burns.
Anastomosis between the esophagus and the graft can be done in four ways: end-to-end, side-to-side, gut-to-esophagus, and esophagus-to-gut. Here is a description of the side-to-side method.
The lateral wall of the esophagus is taken on two silk holders and, having laid the graft next to it, the first row of interrupted serous-muscular sutures is applied with #3 silk. The surgical field is isolated with napkins, the esophagus and intestine are opened longitudinally, their contents are removed by suction and a second row of interrupted catgut sutures is applied through all layers. Then, in the same order, the anterior walls of the anastomosis are sutured, tying the knots of the catgut suture into the lumen.
At the end of the anastomosis, the surgeon decides what to do with the underlying segment of the esophagus. Various options are possible: intersection with suturing, excision of a part of the esophagus, etc. A thin rubber drainage is left near the anastomosis so that it does not touch the anastomosis. The skin is sutured tightly.
With pathologies of the alimentary canal, specialists prescribe treatment for the esophagus. This is not an easy task, since therapeutic measures must be comprehensive and include medication, physiotherapy, diet, and in severe cases, a surgical approach is used.
The main goal of treatment is to reduce the symptoms of the disease and increase the period of remission.
There are several schemes, each is selected taking into account the individuality of the patient, based on diagnostic methods. Good additional result How does it help with basic treatment? ethnoscience. Let's take a closer look at how to treat the esophagus.
The main course at the non-erosive stage lasts 1 month. Pump inhibitors or IPP taken once a day. With an erosive lesion, the treatment lasts 2 months, the patient uses the PPI twice a day. The dosage is prescribed by the attending physician, depending on the severity of the inflammation.
Drugs for the treatment of the esophagus are as follows:
After the main treatment course ends, the patient continues to receive maintenance therapy. This is at the same time prevention, since in the absence of treatment, only 25% of patients remain in remission for more than six months. Most patients take medication for the rest of their lives to reduce their risk of developing esophageal cancer.
How to treat the esophagus: treatment regimens
Patients require:
- Therapy takes place with the appointment of the same medication. With this treatment, the brightness of symptoms, changes in soft tissues, and complications are not taken into account. This approach is ineffective, in severe forms it can be harmful to health.
- Enhanced therapy - the patient is prescribed different drugs with varying degrees of aggressiveness at certain stages of inflammation,. When the desired result does not occur, the doctor combines similar medications, but with a stronger effect.
- In the third scheme, the patient takes proton pump blockers with strong action. When the bright signs subside are used prokinetics with weak action. This scheme has an impact on health with best effect used to treat severe reflux disease.
Medical treatment should be two-stage. At the first stage, the mucous membrane returns to normal, the second stage helps to increase the duration of remission. The second approach is chosen together with the patient at his request for his own convenience.
The duration of drug treatment and the amount of dosage will depend on the severity of the inflammation. Usually the doctor prescribes two drugs from different groups. Combined prokinetics, antacids, antisecretory agents. healthy image life, diet, diet helps to achieve a successful result in a shorter period of time.
Esophageal surgery for reflux esophagitis
You should not use a request such as a German esophageal surgery specialist, since domestic medicine and its capabilities are at a decent level. Surgery for reflux esophagitis is done with a laparoscope without incisions. From the stomach, the surgeon forms a special cuff that prevents reflux. This approach completely cures patients with reflux esophagitis.
Indications for surgery:
Suitable for those patients who have a severe course of GE reflux disease. As a rule, the advanced stages are treated with drugs ineffectively, the revision of the diet also does not give a result.
In this case, patients get rid of lifelong medication. At the end of rehabilitation, the person feels a significant improvement, the sphincter is working normally.
The decision on the operation is made by the gastroenterologist after consultation with the surgeon, nutritionist. If necessary, a consultation with all specialists is assembled.
Removal of the esophagus followed by plasty
This surgical intervention takes place with the opening of the abdominal and chest cavity, the prognosis is unfavorable. The operation is done with oncology or other dangerous lesions.
After the complete removal of the esophageal tube (a procedure called extirpation of the esophagus), it is replaced artificially, the graft is made:
- from a tubular flap of the stomach, which is formed from a large curvature;
- use intestinal loops for this;
- an artificial esophagus is created immediately or some time after the first operation.
At the latest technologies the operation has a better prognosis, it is less traumatic, takes a short period of time. Manipulation is performed through the subcutaneous tunnel with special instruments. The esophagus is cut off through an incision in the neck and a small incision in the epigastric region. Through this tunnel, an artificial esophagus is inserted from the loop of the small intestine and sutured. Possible plastic surgery of the esophagus with the colon.
Resection of the esophagus
This radical operation to remove a section of the esophagus is performed when cardiospasm, at tumors diverticula(), hernias, congenital pathologies. At the same time, an artificial esophagus is formed, which saves the patient from repeated reconstructive plastic surgery.
Palliative Surgery
Palliative surgery can be performed traditional way, laparoscopic and endoscopic methods. In the first situation, access to the channel is carried out by direct opening of the chest, abdominal cavity. The method provides good access to the organ, but is dangerous with consequences in the postoperative stage.
- the imposition of a gastrostomy;
- vein sclerotherapy.
Ligation of esophageal varices
What does doping the esophagus mean? Against the background of liver cirrhosis, viral hepatitis, chronic alcoholism, the vascular bed is restructured, the blood pressure in the portal vein increases, and the blood flow is redistributed. In this case, the veins of the esophageal canal become dilated, tortuous, the walls can subside, protrude into the lumen of the canal.
This condition raises the risk of bleeding inside the esophagus - this is the most dangerous sign of portal hypertension.
By way of introduction fibroesophagoscope produced ligation and sclerosing esophageal vessels.
- the device with nozzles is inserted through the mouth, reaches the lumen of the esophageal canal, the doctor sees altered vessels on the monitor screen;
- then, with the help of suction, the varicose areas are attached to the nozzle, a latex ring is put on them.
In the process, cyanotic balls are formed, which fall off at the end of the first week. Then the ligatures are excreted from the body naturally. After the ligature falls off, an ulcerative surface is formed, it epithelizes within 15-20 days.
Endoscopic procedures
They are made in order to remove benign tumors, polyps, for cauterization with a laser, for exposure to liquid nitrogen. Esophagoscopy is administered through the mouth, it has special loops, forceps, electrodes. Using this method, a piece of tissue is also taken for subsequent histological examination.
Useful video
We dealt with the questions of how to cure the esophagus, and which doctor treats the esophagus. The information provided in this video will also be helpful.
The Importance of Diet
How the postoperative period will proceed depends on the patient, on compliance with medical recommendations, where the diet plays an important role. The diet is chosen on an individual basis, depending on the nature of the intervention. Complete Diet should contain a lot of protein, a normal amount of fat.
Characteristics of the diet:
All types of alcohol, chocolate, ice cream should be excluded, canned food, smoked sausage, meat and fish semi-finished products are not recommended. The patient should not eat marinades, hot spices, smoked and salty foods. Onions, radishes, garlic, mushrooms, sorrel are also excluded. Sour varieties of fruits and berries should also not be included in the diet: you will have to give up lemons, apples, gooseberries, currants, cherries.
The esophagus is the food conduit. If the esophagus does not have pathological processes and functions normally, then food easily passes into the stomach.
If suddenly a patient is diagnosed with a serious pathology that requires removal of the esophagus, then doctors must do everything to save it. If doctors do not have such an opportunity, then it is necessary to replace the esophagus with something. That's what esophageal plastic surgery is for.
When is esophageal plasty indicated for patients?
There are several moments when specialists prescribe an esophageal plasty to a patient. First of all, it is indicated for patients who have a congenital absence or acquired fusion of natural openings and channels in the esophagus. The doctor also prescribes plastic surgery for damage to the esophagus, which is caused by a long stay of a foreign object in it.
Often, such operations are prescribed due to burns, which act as diffuse leiomatosis and inflammatory pseudotumors. Another indication for plastic surgery of the esophagus is the frustrated active movement of the walls of the esophagus.
What is esophagoplasty
When performing an esophageal plastic surgery, specialists insert a so-called “esophageal graft”. It must be straight and without sharp bends.
If the graft does not meet these characteristics, then the patient will need to undergo regular esophagoscopy (diagnosis of the inner walls of the esophagus by inserting an esophagoscope) and dilation. As a rule, the main purpose of the graft is to act as a passive conductor.
Whatever the plastic, it is very important that a reverse flow of contents from the stomach into the graft itself is created. Therefore, the best substitution of the esophagus is the one that fully connects the esophageal-gastric section with the esophagus section.
It is very important that the plastic is of high quality, since it is necessary to avoid bougienage of individual elements of the esophagus.
In medical practice, there are three main methods of esophageal plasty, namely:
- installation of a colonic transplant;
- installation of a gastric tube;
- installation of a jejunal graft.
It is not uncommon for doctors to move the stomach to the chest area.
Segmental plasty of the esophagus according to the method of G. E. Ostroverkhov and R. A. Toshchakov
At the heart of this technique, specialists are faced with the task of excising a segment of the required size from the small intestine, which will have one or two vascular legs. The excised segment must be connected to the edge of the esophagus, where the resection was performed. Thus, the full and continuous functioning of the esophageal tube will be restored.
At the beginning of the operation, specialists cut and open the abdominal cavity and find the part of the intestine where the arcades and intestinal arteries are most pronounced. The plot must be at least 9 centimeters. Vessels that depart from the arcades are tied up at a distance of 30 centimeters, then the operation itself is performed.
During surgery, doctors may shrink or enlarge the esophagus. It all depends on the volume of the esophageal resected area.
Esophageal plasty with a graft from the left side of the colon on the left colic vessel is considered the most best method. Thus, the esophagus is replaced in patients diagnosed with a benign stricture.
The length and volume of the graft is sufficient to replace the entire esophagus, and sometimes even a certain part of the pharynx (of course, if there are serious indications for this).
After such a surgical intervention, the blood supply from the left colic vessel to the right is restored in patients, and the state of blood circulation is sufficient for food to pass unhindered. Also, after the operation, full-fledged anastomoses are created.
The marginal vessels and walls of the intestine itself are closely connected after surgery, so the direct graft does not increase in length with time and does not twist. In the process of digestion of solid food, the left half of the large intestine is involved, the second is less involved.
In addition, if the left half of the colon is removed, then there will be fewer problems in the future than if the right one is removed. Conducting instrumental and laboratory methods diagnostics have determined that the colon is more resistant to acidity, so doctors very rarely diagnose ulcers in the graft.
Plastic in children
For children, the situation is a little more complicated. Before deciding on the method of plastic surgery, it is necessary to conduct a complete diagnosis of the child's body. A child is allowed for surgery only if he has no problems with the cardiovascular system.
If a child had a retrosternal plasty, then in the future it is very difficult to get to the heart. Also, if the child has previously undergone heart surgery, then it is necessary to choose a different method of therapy, and not retrosternal.
If at birth the baby does not have natural openings and channels in the corresponding organ, and there is no distal tracheoesophageal fistula, and doctors decide to lengthen the esophageal segments, then they may prescribe surgery immediately after birth.
Recently, however, pediatric specialists in such cases have resorted to cervical esophagostomy and gastrostomy, but esophageal plastic surgery is performed six months after birth. In some cases, surgery may be delayed until 2 years of age.
In any case, there are advantages that have been confirmed for more than a dozen years. After conducting many such operations, experts came to the conclusion that they are best done not immediately after birth. But this statement is controversial, because if a child eats in a non-natural way, that is, not through the mouth, for two or three months, then perhaps he will get used to this and will never eat normally.
Therefore, if a child has been diagnosed with a gastrostomy, then feeding should be carried out through a hole in the wall of the organ and through the mouth. Thus, the stomach will be fully filled, and the child will develop the habit of eating through the mouth. So the baby will learn to swallow. It is very important to always diagnose pathological processes in the body in a timely manner. Thus, serious consequences and complications can be avoided. Remember that timely preventive examinations are the key to your health.