Video-assisted techniques in surgery of benign esophageal diseases

The aim of this study was to investigate the clinical results of the surgical treatment of the patients with benign esophageal diseases (total and subtotal strictures and end-stage achalasia or cardiospasm) after video-assisted and open subtotal esophageal resection with esophagoplasty.

Material and methods. Between 2010 and 2018 years in the Surgical Department # 1 of Petrovsky National Research Center of Surgery 57 subtotal esophageal resections with esophagoplasty were performed in patients with benign esophageal diseases. 29 procedures (1st group) were made by video-assisted surgery, including 20 thoracoscopic esophageal resections with laparotomy and 9 total minimally invasive esophageal resections. 28 open procedures (2nd group) were performed: 9 – using transthoracic approach, 19 – transhiatal approach.

Results. The groups were similar in terms of age, gender, diagnosis and physical states. The average time of the transthoracic operations in the 1st group was lower than in the 2nd group (447 [390; 540] vs 470 [382; 700] min, p=0.317), but the time for all operations was higher in the 1st group (p=0.002). The conversion was performed in 2 (7%) cases and caused by technical difficulties during esophageal mobilization. Average blood loss was statistically lower in the 1st group than in the 2nd group (250 [112; 337] vs 400 [300; 600] ml, p=0.01). Postoperative respiratory complications were detected in the 17% of the patients in the 1st group, and in 50% – in the 2nd group (p=0.012). The rate of the other complications including anastomosis leaks, vocal cord paresis, and surgical site infection was similar in both groups.

Conclusion. Video-assisted subtotal esophageal resection may be considered as an effective alternative for open procedures in patients with benign esophageal diseases because of lower blood loss and postoperative respiratory complications rate.

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