RESUMO
OBJECTIVE: To investigate whether the use of the stomach as a substitute after oesophageal resections causes disturbances in vitamin B12 absorption due to deficient intrinsic factor (IF) production. MATERIAL AND METHODS: Eleven patients operated upon with oesophageal resection a.m. Ivor Lewis, for malignant (10) or benign (1) conditions of the oesophagus were examined with a postoperative dual isotope technique 11-41 months (mean 25 months) after operation. RESULTS: In two patients the test showed abnormally low absorption of vitamin B12. One of these probably due to incomplete urine collection during the test period. However, no patient showed deficient intrinsic factor production with absorption ratios between vitamin B12 +/- IF of 0.87-1.14 (reference interval: 0.70-1.20). CONCLUSION: Deficiency of intrinsic factor is neither an obligatory nor a common occurrence after oesophageal resection with gastric substitute. However, vitamin B12 absorption may be low due to other factors, and should be looked for in all patients surviving more than a couple of months postoperatively.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Fundo Gástrico/transplante , Fator Intrínseco/biossíntese , Células Parietais Gástricas/metabolismo , Vitamina B 12/metabolismo , Absorção , Idoso , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Vitamina B 12/análiseRESUMO
Ischemia of the gastric tube during use as an esophageal substitute may have serious consequences. We describe a method to correct substernal gastric tube ischemia using the left internal thoracic artery as a source of arterial inflow to a short gastric artery. This permitted successful reconstruction of the upper alimentary tract in this patient.
Assuntos
Anastomose Cirúrgica , Isquemia/cirurgia , Estômago/irrigação sanguínea , Retalhos Cirúrgicos/efeitos adversos , Artérias Torácicas/cirurgia , Idoso , Perfuração Esofágica/cirurgia , Feminino , Seguimentos , Fundo Gástrico/irrigação sanguínea , Fundo Gástrico/transplante , Humanos , Estômago/transplanteRESUMO
The surgical treatment of esophageal strictures, developing on the basis of reflux esophagitis keeps on being an unsolved problem. A review of the literature is made and Thal's operation is given due consideration. The first successfully operated patient by this operative technique in Bulgaria is reported. The patient has been under observation, and the result of the operation is good.