CHOICE OF THE METHOD FOR FORMING AN ISOPE RISTALTIC GRAFT FROM THE STOMACH FOR TOTAL ESOPHAGOPLASTY

An anatomical experiment was conducted on 50 cadavers of human adults and an acute experiment on 50 unbred dogs to choose the most rational method for forming an isoperastaltic graft from the stomach for total esophagoplasty. The anatomo-experimental study was concerned with the peculiarities of angioarchitectonics and the merits and shortcomings o f some methods for lengthening gastric grafts. The macro- and microcir culation in the modelled isoperistaltic gastric grafts of various widt h and configuration was studied in the animal experiments. It was show n that the best gastric graft was an isoperistaltic tube measuring 2.5 cm at the base, formed by the authors' suggested method of angular di vision of the gastric walls above the pylorus, and with a dilatation i n the proximal part (beginning 4 cm below the level of division of the main vascular arcade) up to 3.5 cm in size. When the length of the gr eater curvature of the stomach from the lower pole of the spleen to th e pylorus, measured in mild stretching of the tissues (before mobiliza tion of the stomach) is less than 20 cm it is advisable that the vascu lar connections in the hilus of the spleen are included in the nutrien t-supplying pedicle of the graft to improve the supply of blood to its proximal segment. The method for formation of the gastric graft along a broken line was used in the clinic in 300 operations for extirpatio n of the esophagus with one-stage esophagoplasty. Necrosis of the graf t wad nos encountered. Total postoperative mortality was 3%. It is con cluded that wider introduction of this operation into clinical practic e is expedient.