Guest guest Posted August 4, 2006 Report Share Posted August 4, 2006 Do you by chance have Dr. s office ph #? Thx M. > > , > > In response to your question as to what " anastomotic dilatation " is - it is > a dilatation at the connection area where they hook up your stomach to > wherever your esophagus removal point is. Dr. s in Rochester, NY > mentioned this to me as well as a possibility. Basically it's typically a > result of too much scar tissue forming. He indicated that the dilatation is > very easy compared to what we go through now with dilatations, and usually > the people that need them tend to need one or two and then that's it. He did > not give me a percentage of how many he sees, but did not see it as a major > side effect or risk. > > Not to trivialize any of this, but needing one or more anastomotic > dilatations is the least of our worries if we go through with this surgery. > > in NY > > > > _____ > > From: achalasia [mailto:achalasia ] On Behalf > Of cynmark24@... > Sent: Thursday, August 03, 2006 9:36 PM > achalasia > Subject: Re: Re: Esophagus Removal Mortality > > > > n, > > > > Thank you for digging up the two abstracts on Esophagectomies, the first > being Achalasia specific. Along with the others who have posted here about > the mortality rates, those of us facing E'ectomies clearly understand that > since we are otherwise healthy our odds for success should naturally be > better than the overall average. > > > > This is why it seems strange to me that when Dr. Altorki (the thoracic > surgeon) was " selling " me on the surgery, he quoted me a number of 5% > mortality for the operation knowing full well that I am not one of his > cancer patients. Why then, did he not say, that the mortality was 1% for > healthy achalasia patients. Doesn't make sense. Maybe there is some kind > of law or code of ethics here stating that when you tell a patient the > mortality stats you must tell them the hospital average, or national > average, and you're not permitted to give better statistics if the patient > does not fit the usual profile (cancer). Just a thought. Maybe I'll ask my > daughter that question. > > > > He did give me a leak rate of 10% precisely matching the number you > quoted in the abstract (below). > > > > n, it appears to me that this operation is no walk in the park. > It is full of places for things to go wrong, that get hidden from view, such > as > > > > " Major complications included anastomotic leak (10%), recurrent laryngeal > nerve injury (5%), delayed mediastinal bleeding requiring thoracotomy (2%), > and chylothorax (2%). There were 2 hospital deaths (2%) from respiratory > insufficiency and sepsis. " > > > > And then to top it off > > > > " nearly 50% have required an anastomotic dilatation. " > > > > Excuse me for a sec, its time that I googled. > > > > (15 minutes later) > > I have to confess, I'm having trouble nailing down exactly what it means. > Here is a link for anyone with more patience than I have at the moment. > > > > > > Anastomotic > <http://content.karger.com/ProdukteDB/produkte.asp? Aktion=ShowFulltext & Produ > ktNr=223996 & Ausgabe=227627 & ArtikelNr=52018#SA2> Complications after > Esophagectomy - Karger Publishers > > > > Whatever it is, its not good and its at 50%. > > > > If I must have the surgery and there is no reliable alternative, then I am > not feeling too good at the moment as to what is in store for me. > > > > I did not see a mention either of acid reflux, considering what is going to > be done with our poor stomachs. > > > > Clearly a lot of thought must be given in order to make a decision that we > can go forward with. > > > > Good, bad, or otherwise, whoever brings to this Board additional information > on esophagectomies, I thank you. I thank you for providing me and everyone > else facing this with an additional information giving us a better > perspective. Many of the articles also contain extensive bibliographies > providing even more information. > > > > > > > > > > In a message dated 8/3/2006 8:37:14 P.M. Eastern Standard Time, > rnbriely@... writes: > > Here are two abstracts on esophagectomies. The first is Achalasia specific, > the second is more general. Mortality rates were 2% (n=93patients) and 4% > (n=1085 patients) respecitvely. Perhaps another good number to focus on is > the 95% of patients in the first study who are eating well after the > surgery. > > Best wishes to all of you having to make this difficult decision. > > Regards, > n > > Abstract #1 > Esophagectomy for achalasia: patient selection and clinical experience > > Presented at the Thirty-seventh Annual Meeting of The Society of > Thoracic Surgeons, New Orleans, LA, Jan 29-31, 2001. > > J. Devaney MDa, Mark D. Iannettoni MDa, Mark B. Orringer > MDCorresponding Author Contact Information, E-mail The Corresponding > Author, a and Becky Marshalla > > a Section of Thoracic Surgery, Department of Surgery, University of > Michigan Medical Center, Ann Arbor, Michigan, USA > > Abstract > > Background. In 1989, we predicted an increasing number of > esophagectomies for megaesophagus and for recurrent symptoms after > prior esophagomyotomy or balloon dilatation for achalasia. Patient > selection in this group is challenging, as the potential operative > morbidity of an esophagectomy must be weighed against the expected > clinical outcome after a redo esophagomyotomy or alternative > procedures designed to salvage the native esophagus. > > Methods. The hospital records of 93 patients undergoing esophagectomy > for achalasia during the past 20 years were reviewed retrospectively > and the results of operation assessed using our prospectively > established Esophageal Resection Database and follow-up information > obtained through personal contact with the patients. > > Results. Patient age averaged 51 years. Indications for esophagectomy > included tortuous megaesophagus (64%), failure of prior myotomy (63%), > and associated reflux stricture (7%). Ninety-four percent of the > patients underwent a transhiatal esophagectomy. Stomach was used as > the esophageal substitute in 91% cases. Intraoperative blood loss > averaged 672 mL. Postoperative length of stay averaged 12.5 days. > Major complications included anastomotic leak (10%), recurrent > laryngeal nerve injury (5%), delayed mediastinal bleeding requiring > thoracotomy (2%), and chylothorax (2%). There were 2 hospital deaths > (2%) from respiratory insufficiency and sepsis. Follow-up has averaged > 38 months. In all, 95% of patients eat well; nearly 50% have required > an anastomotic dilatation; troublesome regurgitation has been rare; > and 4% have refractory postvagotomy dumping. > > Conclusions. Esophagectomy, preferably through a transhiatal approach, > is generally safe and effective therapy in selected patients with > achalasia. Unique technical considerations include difficulty > encircling the dilated cervical esophagus, deviation of the esophagus > into the right chest, large aortic esophageal arteries, and adherence > of the exposed esophageal submucosa to the adjacent aorta after prior > myotomy. > > Abstract #2 > Transhiatal esophagectomy for treatment of benign and malignant > esophageal disease > > Orringer, M B; Marshall, B; Iannettoni, M D > > Section of General Thoracic Surgery, Department of Surgery, University > of Michigan Medical Center, 2120 Taubman Health Care Center, 1500 E. > Medical Center Drive, Box 0344, Ann Arbor, Michigan 48109, USA; e- mail > morrinumich (DOT) <mailto:morrin%40umich.edu> edu > > Abstract > > Since our initial 1978 report, we have performed transhiatal > esophagectomy (THE) in 1085 patients with intrathoracic esophageal > disease: 285 (26%) benign lesions and 800 (74%) malignant lesions > (4.5% upper, 22% middle, and 73.5% lower third/cardia). THE was > possible in 97% of patients in whom it was attempted; reconstruction > was performed at the same operation in all but six patients. The > esophageal substitute was positioned in the original esophageal bed in > 98%, stomach being used in 782 patients (96%) and colon in those with > a prior gastric resection. Hospital mortality was 4%, with three > deaths due to uncontrollable intraoperative hemorrhage. Major > complications included anastomotic leak (13%), atelectasis/pneumonia > prolonging hospitalization (2%), recurrent laryngeal nerve paralysis, > chylothorax, and tracheal laceration (< 1% each). There were five > reoperations for mediastinal bleeding within 24 hours of THE. > Intraoperative blood loss averaged 689 ml. Altogether, 78% of the > patients had no postoperative complications. Actuarial survival of the > cancer patients mirrors that reported after transthoracic > esophagectomy. Late functional results are good or excellent in 80%. > Approximately 50% have required one or more anastomotic dilatations. > With intensive preadmission pulmonary and physical conditioning, use > of a side-to-side staple technique (which has reduced the cervical > esophagogastric anastomotic leak rate to less than 3%), and > postoperative epidural anesthesia, the need for an intensive care unit > stay has been eliminated and the length of hospital stay was reduced > to 7 days. We concluded that THE can be achieved in most patients > requiring esophageal resection for benign and malignant disease and > with greater safety and less morbidity than the traditional > transthoracic approaches. > Quote Link to comment Share on other sites More sharing options...
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