Malignant tumor developed in colon-esophagus.

This case report describes a very rare late complication developed in the colon-esophagus. An adenomatoid polypus malignant tumor appeared in a colonic interposition graft, five years after resection of the esophageal stricture. The continuity of intestinal tract was repaired with a Roux-en-Y esophago-jejunostomy. Based on a literature review, the authors detail late complications of operations which replace the esophagus with colon.

The role of ultrasound-guided percutaneous transhepatic aspiration of the gallbladder content in the management of hydrops/empyema caused by acute cholecystitis.

Ultrasonically guided percutaneous transhepatic gallbladder aspiration (UG-PTGA) was used in the treatment of hydrops caused by acute cholecystitis in 21 patients. The interventions had no complications. This kind of aspiration is believed to be suitable for the relief of gallbladder tension causing acute complaints and of subsequent pathological changes.

[Spontaneous esophageal perforation related to fungal esophagitis]. / Gombás oesophagitis talaján kialakult spontán nyelöcsö perforatio.

The authors give account of spontaneous esophageal perforation developed on the basis of fungal oesophagitis. The lesion of the lower third of the esophagus classified as grade 4. on Kodsi classification displayed the same picture as an advanced esophageal cancer. They review signs, symptoms and varieties in macroscopic appearance of esophageal candidiasis. They warn that in case of a spontaneous perforation of "malignant" esophageal tumor with no preceding signs the rare condition of fungal esophagitis must certainly be considered.

[Postoperative percutaneous endoscopic gastrostomy/jejunostomy]. / A postoperativ szakban készített percutan endoscopos gastrostoma/jejunostoma.

In order to cure complications appeared in the postoperative period two patients were treated with percutaneous endoscopic gastrostomy/jejunostomy (PEG, PEGJ) with the purpose of long-lasting enteral feeding and decompression. The indications of PEG/PEGJ were the following: external gastric fistula in one case and anastomotic leakage in one case. In the patients the PEG was located by intraoperative X-ray examination, this method was not published earlier. Regarding complications of the early postoperative period the PEG and the PEGJ are considered useful and expedient procedures with the aim of lasting enteral feeding and decompression.

[Endoscope-assisted laparoscopic resection of the gastric wall]. / Endoscoppal asszisztált laparoscopos gyomorfal-resectio.

The early gastric carcinomas measuring 10-25 mm in diameter, macroscopically I-II/C types and benign gastric tumours are relegated to laparoscopic wedge resection of the stomach. Authors report on the use of a new endoscopic assisted--"double-lifting"--laparoscopic resection of the gastric wall, in the course of removal of an early stage gastric carcinoma (13 mm in diameter, macroscopically II/C type) and a gastric lipoma (21 mm in diameter). The advantage of this method: the affected gastric wall could be removed safely far from the lesion and all layers of the gastric wall are available for histological examination.

[Synchronous surgical removal of esophageal and pulmonary cancer by endoscopic mucosectomy and video-assisted lobectomy through minimal thoracotomy]. / Szinkrón nyelöcsö-és tüdöcarcinoma eltávolítása endoscopos mucosectomiával és videoasszisztált mini thoracotomiából végzett lobectomiával.

Authors report a case of a 75 year old, male patient suffering from an early stage squamous esophageal cancer and a synchronous adenocarcinoma of the lung. The patient was operated on simultaneously at the same setting: the esophageal tumour was taken out by endoscopic mucosectomy, whereas the pulmonary cancer was removed by video assisted minimal thoracotomy. The definitive histological diagnosis was: squamous cell cancer (muscular mucosal cancer) (pT1) of the esophageal lesion and adenosquamous cancer (pT2) of the lung. Authors draw attention on the significance of the early diagnosis of malignant tumours, and in this case minimally invasive endoscopic procedures can be successfully performed.

Dilation of strictures after esophageal resection and reconstruction.

Dilation has remained an indispensable method of therapy for postoperative esophageal stricture even nowadays. Dilation with proper equipment and instruments of esophageal stricture after resection is a safe procedure. It can be performed most effectively and with reduced danger by Savary-Gilliard instrument or balloon. If it is only scar and there is no relapse, dysphagia starts mostly within 2-3 months after the operation. In the case of local relapse the postoperation stenosis gives rise to dysphagia later. The possible presence of postoperative fistula does not contraindicate stricture dilation. In fact, the dilation of narrow anastomosis helps the closure of the fistula.

Nonoperative management of esophageal perforations. Is it justified?

OBJECTIVE: Experiences obtained with nonoperative treatment (NOT), i.e. total prohibition of per oral food intake for a minimum of 7 days, administration of combinations of broad-spectrum antibiotics, and parenteral hyperalimentation, are described in the management of esophageal perforations. SUMMARY BACKGROUND DATA: The place, value, and indication of NOT in the management of esophageal perforation has not yet been unequivocally defined. As a result, contradictory data have been published regarding the outcome of NOT. METHODS: During the past 15 years (1979 to 1994), 20 of 86 patients (23.3%) with esophageal perforation have been treated nonoperatively from the outset. In this group, perforations were located to the upper, middle, and lower third of the esophagus in 50%, 30%, and 20%, respectively. In the operative management group (OT)--in which conservative (drainage, endeprothesis), reconstructive (suture, reinforced suture), and radical (resection) surgical methods were applied--lesions were preponderantly located in the lower one third of the esophagus (56.1%--37/66). As to the interval between the perforation and the onset of treatment, 14 patients had been diagnosed within 24 hours, whereas in 6 cases treatment had been begun beyond 24 hours. RESULTS: NOT could be successfully carried out in 16 patients; the decision to use NOT had to be revised in 4 other cases (Table 1). Two patients were lost; the mortality rate was 10% (2 of 20). The rate of complications was lower in the NOT group (20%, or 4 of 20) than in the OT group (50%, or 33 of 66). CONCLUSIONS: NOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.

Management of failed Heller's operations.

An analysis of 29 patients who collectively required 33 reoperations for failed Heller's esophagocardiomyotomy performed during the period between 1972 and 1992 was conducted. In the majority of patients, the reoperation was necessitated because the original myotomy was not long or deep enough, or because of iatrogenic gastroesophageal reflux and its sequelae such as strictures. Identification of the exact cause of failure requires careful analysis of the patient's symptoms and of the findings of various diagnostic examinations. The treatment for inadequate myotomy generally involves performing a second myotomy, which is completed by adding a nonobstructive antireflux repair. It appears that abolition of the "sigmoid sac" is essential even when the esophagogastric junction has a sufficiently large diameter. A so-called esophagoplication was performed in 3 patients,and an interposition at the site of esophageal resection, using an isoperistaltic esophagojejunogastric loop of appropriate length, was performed in 14 patients. There were no deaths following reoperation. In fact, the results were excellent or good in 23 cases and fair in 3.

[What kind of surgical radicality is justified in the treatment of esophageal and cardial carcinoma?]. / Wie radikal soll das Osophagus- bzw. Kardiakarzinom operiert werden?

In the period from January 1, 1973 to November 30, 1994, a total number of 1 856 patients had been admitted to our Department of Surgery because of cancer of the esophagus and esophago-gastric junction. We divided our activities into two study periods. In the first study period from 1973 to 1984 only so called "conventional operations" were performed. Since 1985 new oncological aspects were introduced into our operative tactics:1. the subtotal esophagectomy combined with the two-field lymphadenectomy,2. the total gastrectomy with extended lymph node dissection. The analysis of our results with respect to the survival parameters (TNM staging, histological type, grade of differentiation, gross pathology) showed that the best chances were obtained by curative resection and lymphadenectomy in tumours of low-grade biologic malignancy. In esophageal cancers the former 6 % 5-year cumulative survival rate increased to 26 %, and in cardia tumours from 9 to 27 %, because of enhancement of radicality and extension of lymphadenectomy.