Abstract:Bypass with a Roux-en-Y loop is proposed for palliation of nonresectable malignant obstruction in the distal oesophagus and cardia without peritoneal dissemination. Over a 15-year period, 51 transdiaphragmatic Roux-en-Y procedures with side-to-end oesophagojejunal anastomosis were performed. The 11.8% mortality was unrelated to anastomotic leakage. Gastrostomy should be avoided because of its nutritional and psychologic disadvantages. Other methods for surgical bypass are discussed and comparison is made with … Show more
“…Many modifications have been made to its original form [2, 8, 9, 10]. Jejunum [11, 12, 13]colon [14, 15], isoperistaltic [16, 17, 18, 19]and antiperistaltic [20]gastric tube conduits have also been used for palliative bypass.…”
Surgical bypass for the palliation of dysphagia in patients with unresectable oesophageal carcinoma continues to be an option in developing countries, as the cost of a good quality endo-prosthesis is well beyond the means of most patients. One such case is presented in which an in-continuity fundic bypass (without resection of the lesser curvature and cardia, thereby not disconnecting the oesophago-gastric junction) was made with gratifying results with regard to quality of life. Awareness of this previously unreported procedure is important because it adds to the armamentarium of surgeons wanting to provide palliation for dysphagia and aspiration in patients with unresectable carcinoma of the oesophagus.
“…Many modifications have been made to its original form [2, 8, 9, 10]. Jejunum [11, 12, 13]colon [14, 15], isoperistaltic [16, 17, 18, 19]and antiperistaltic [20]gastric tube conduits have also been used for palliative bypass.…”
Surgical bypass for the palliation of dysphagia in patients with unresectable oesophageal carcinoma continues to be an option in developing countries, as the cost of a good quality endo-prosthesis is well beyond the means of most patients. One such case is presented in which an in-continuity fundic bypass (without resection of the lesser curvature and cardia, thereby not disconnecting the oesophago-gastric junction) was made with gratifying results with regard to quality of life. Awareness of this previously unreported procedure is important because it adds to the armamentarium of surgeons wanting to provide palliation for dysphagia and aspiration in patients with unresectable carcinoma of the oesophagus.
The palliative effect of endoscopic Nd:YAG laser treatment of malignant strictures of the oesophagus and cardia was prospectively evaluated in 30 patients. Most (n = 28) were primarily treated for dysphagia, and swallowing was improved in 21 and normalized in 14 of these patients. Two patients were successfully treated for bleeding. Six patients developed complications (including two perforations), and four of these were fatal. The median survival was 4 months (range, 17 days to 14 months). It is concluded that in a great number of patients with inoperable cancer of the oesophagus and cardia, laser treatment is better than other palliative procedures.
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