Biomedical subjects

Z Popovici

Publications and source records attributed to Z Popovici.

At least 19 recordsLinked to original sources

PubMed2003

A new philosophy in esophageal reconstruction with colon. Thirty-years experience.

The author reports a personal series of 347 patients with colon interposition grafting as an esophageal substitute, the majority of them carried out for corrosive pharyngoesophageal strictures (284) followed by malignancy (54). A personal philosophy is exposed, based on increased flexibility in the choice of the type of colic interposition depending on the pattern of blood supply. This mobile policy called 'balanced operation' is opposed to the classic rigid approach based on the use of a single procedure of esophagocoloplasty. The author's choice is the ileocecum with long ileal loop (65 cm), favoring preservation of the ileocecal valve, and conferring an antireflux mechanism. In particular cases the cecum may be removed and an ileal graft carried out. If this arrangement is not feasible one should slide toward the left in a clockwise direction performing a left colon interposition (iso- or antiperistaltic). Overall mortality was of 16 cases (4.6%). Morbidity is analyzed and different particular arrangements like continuous colic loop, superlong graft, Roux-en-Y procedure are described. A general outline of pharyngeal reconstruction in corrosive strictures is presented.

Anastomosis, Roux-en-Y↗

PubMed1998

[Results of the surgical treatment of severe caustic pharyngo-esophageal stenosis. The value of complete reconstruction of the pharynx by transposition of the ileum and colon].

STUDY AIM: The aim of this study was to report the results of pharyngoesophageal reconstruction in extensive corrosive strictures and to describe an original conception concerning extensive chemical burns of the pharynx with involvement of the epiglottis, oro-hypopharyngeal junction and cricopharyngeal pinchcock. PATIENTS AND METHODS: A personal series of 253 esophageal reconstructions using the colon and ileum is reported. In 124 patients, the cervical anastomosis of the graft was performed at the level of the pharynx, and these cases with extensive pharyngeal lesions were the basis of this study. The anastomosis was performed with the hypopharynx in 27 patients, with the oropharynx in nine and a total reconstruction of the pharynx or "pharyngoplasty" was carried out in 69 patients. The pharyngoplasty was classified according to the approach, in anterior, posterior, lateral, superior (transmandibular) and inferior. In high strictures with epiglottic injury, epiglottectomy was necessary in order to prevent recurrence. A visceral pharyngoplasty was performed in 61 patients, using the colon in 42 and the ileum in 19, a skin reconstruction in six patients and a myocutaneous flap in two. RESULTS: The global postoperative mortality rate was 4.7%. Stenosis of the cervical anastomosis occurred in 4.9% of the whole series. With a follow-up from 6 months to 10 years, 70% of the patients resumed a normal oral diet, 21% had mild symptoms and 7% had poor results (patients with tracheostomy and gastrostomy). CONCLUSION: Extensive chemical burns of the pharynx are very severe and their treatment very difficult. For the author, total visceral pharyngeal reconstruction is considered to be the procedure of choice, using ileopharyngoplasty with realization of an ileal pouch. Good results were obtained in 70% of the patients with extensive corrosive strictures.

Anastomosis, Surgical↗

PubMed1997

Stenosis of the esophagus in cicatricial pemphigoid resolved by colon interposition: report of a case.

We present herein the exceedingly uncommon case of a patient with cicatricial pemphigoid (CP) who gradually developed conjunctival, oral, and esophageal involvement. Despite long-term medical management with dapsone and disulone, the ocular lesions progressed to produce further scarring, which led to ankyloblepharon, symblepharon, and ultimately, blindness of the right eye. After a period of 5 years the patient developed a total esophageal stricture, intractable by dilation, necessitating esophageal reconstruction. The details of an original procedure using a continuous colic loop are described, highlighting the better tolerance of this technique by a high-risk patient. A discussion on the recent advances in diagnosing bullous dermatoses is presented following this case report.

Colon↗

PubMed1989

About reconstruction of the pharynx with colon in extensive corrosive strictures.

The author presents a series of 235 esophagocoloplasties, in 90 cases a pharyngeal reconstruction being performed. The colic graft was anastomosed to the hypopharynx in 43 cases, to the oropharynx in 14 cases, and in 33 cases a pharyngoplasty was done. A personal classification of the approach of the pharynx according to local innervation is attempted, and various original procedures of pharyngeal reconstruction are described (double pharyngoplasty "en Y", pharyngoplastia "vera"). A great effort was made in preservation of the larynx, which remains the main aim of the author.

Anastomosis, Surgical↗

PubMed1986

[Double Y pharyngocolostomy. An original procedure].

An original procedure is presented which involves cervical anastomosis after colic esophagoplasty, allowing double drainage of pharynx. As a function of permeability of esophagus, two variants are described: "esophagopharyngocolostomy in Y" and "double pharyngocolostomy in Y". The operation is performed as either a one-stage (immediate) or, more frequently a two-stage procedure: to correct tracheal reflux after high pharyngocolic anastomosis (with oropharynx); in low end-to-side esophagocolic stenosis with colic tube in excess and in narrow caliber sclerous esophagus. This method was used in 6 cases of post-caustic esophageal stenosis with very good long-term results. The method is an anti-reflux procedure which also ensures prophylaxis of recurrent stenosis of the cervical anastomis.

Adult↗

PubMed1985

[Total "pharyngoplastia vera" with the colon in caustic pharyngo-laryngeal stenoses].

An original procedure for pharyngeal reconstruction with colon in pharyngolaryngeal stenosis due to chemical burns has been named "pharyngoplasty vera" by the authors, since the 3 walls of the pharynx are reconstituted by lining it with visceral material. This is in contradiction with previously used techniques in which the graft caps the pharyngostomy produced by resection of scar tissue (pharyngovisceral anastomosis). The procedure generally respects the principles of conventional cutaneous pharyngoplasty--similar approach, extirpation of scar tissue, epiglotto plasty, conservation of constrictor muscles and above all, solid attachment of visceral material to the latter, and finally suture of the colon at the base of tongue and closure of pharynx. The method was used in a patient who regained deglutition rapidly, but the insufficient glottic space did not allow reopening of the canal.

Adult↗

PubMed1984

[Peptic ulcer of the cologastric anastomosis in esophagoplasties].

Two cases of cologastric anastomotic peptic ulcer after esophagoplasty for stenosis from caustic burns are reported, one developing 2 1/2 years and the other 12 years after operation. One case was treated by complex gastrocolic resection and the other by distal gastrectomy with ulcer excision and retrimming of the cologastric anastomosis. Long-term postoperative results were good. The different surgical procedures reported in the literature are discussed, and the value of combined gastrotomy and exploratory colotomy for detection of lesion extension emphasized. The preferred method is complex cologastric resection with conservation of the stomach in the digestive circuit.

Adult↗

PubMed1980

[Surgical approach to esophageal foreign bodies (author's transl)].

Fourteen patients with pharyngo-esophageal foreign bodies are reported. The esophagus was normal in 7 cases, two foreign bodies were ejected spontaneously, one was extracted by endoscopy, two by cervicotomy, one by thoracotomy, and one by cervicothoracotomy. It is rare for dental prostheses to be swallowed, but mention is made of a patient who swallowed a live fish accidentally, and developed cervical emphysema. In 7 cases the foreign body was retained by an esophageal stenosis following previous caustic burns. It was removed by thoracotomy in one case, gastrostomy in 3 cases, colo-esophagoplasty in 2 cases, and by relief of an esophagocolic stenosis in the last case. Long-term results were excellent except for one early postoperative death due to a cerebrosvascular accident, and another from bronchopneumonia at a later stage. Therapy varies according to the condition of the esophagus, the site of the foreign body, and the time when the patient is hospitalized.

Adult↗

PubMed1977

[Surgical attitude in pre-pyloric stenosis due to corrosive substances. Intravascular segmental antrectomy in Y-V. Report of 80 cases (author's transl)].

The author reports 80 cases of gastric stenosis due to caustic substances, of which 20 were limited only to the stomach and 60 were accompanied by esophageal stenosis. In most cases (78.8 p. cent), the site of the gastric stenosis was antral, pre-pyloric and the duration of onset was, on average, 3 weeks. Surgical treatment depended on the extent of the corrosive lesions. In limited antral stenosis, we carried out antrectomy with gastroduodenal anastomosis. In pre-pyloric stenosis situated 3 to 5 cm from the pylorus, the author recommends conservation of the non-functioning pylorus by double pylorotomy and anastomosis with the whole of the border of the stomach, describing a personal procedure named intravascular Y-V segmental antrectomy. The criterion which decides the proximal border of the resection, should be the appearance of the gastric mucosa, the section should pass immediately above the caustic ulceration. In extensive gastric stenosis (more than 75 p. cent) of the stomach and in evolutive corrosive lesions, we recommend Y-shaped jejunostomy, of Maydl type. In post-caustic pre-pyloric stenosis we operated on 76 cases out of 80 with 3 deaths (3.9 p. cent mortality). In 25 patients we carried out esophagoplasty about 6 months after the accident. We preferred restrosternal isoperistaltic coloesophagoplasty by Kelling's procedure. To increase the circulation through the left colic artery and marginal artery, we ligatured the middle colic artery and right colic artery at the same time as the gastrostomy.

Adult↗

PubMed1977

[Special aspects of colo esophagoplasty in post-caustic esophageal stenosis for corrosive stricture of the esophagus (author's transl)].

The author reports 12 cases which illustrate unusual aspects of colo esophagoplasty in post-caustic esophageal stenosis. 8 cases respresented post-caustic pharyngolaryngeal stenosis in which he recommended anastomosis of the colon with the oropharynx according to a personal technical variant. In 1 case associated with amputation of the epiglottis, he carried out a double pharyngo-colic Y-shaped anastomosis. He classified the pharyngotomy types in relation to the 3 main nerves, the lingual, hypoglossal and superior laryngeal nerves. In 3 cases the author carried out successfully retrosternal transposition of a colonic segement 6 months, 1 year and 4 years after pre-thoracic colo esophagoplasty. He reports 1 case of intrathoracic strangling of the colonic tube which occurred 1 year after retrosternal colo esophagoplasty, and wich was cured by intra-vascular vertical clectomy. In all cases the good results were maintained for a long period.

Burns, Chemical↗

PubMed1977

[Angiographic research on the blood supply of the colon with a view to oesophagoplasty (author's transl)].

The author presents an angiographic study of 34 cadavers concerning the colonic vessels, and draws up an original classification of colonic vessels which arise from the inferior mesenteric artery. He found 16 variants of the left colonic artery which he groups into 5 main types, the classical type being only encountered in 22.6 p. cent of cases. In 32 p. cent, the ascending and descending branches of the left colonic artery had a separate origin from the inferior mesenteric artery. The variants of the sigmoid arteries and of the left colonic veins were also identified. In one case, the inferior mesenteric vein was absent, being supplanted by the marginal vein. As for colo-oesophagoplasty, the isoperistaltic transverse colon was found to be better than the ileo-colon in 64 p. cent of cases and equivalent in 20 p. cent. In 16 p. cent the ileo-colon was preferable. The site of the arterial sections in colo-oesophagoplasty according to the colonic vascular type is discussed.

Adolescent↗

PubMed1974