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      Robot-assisted oesophagectomy (Ivor-Lewis) for a complex stenosis previously managed by open gastrostomy tube placement

      case-report
      Author(s): 1 , 2 ,
      Publication date (Electronic):
      Journal: BMJ Case Reports
      Publisher: BMJ Publishing Group
      Keywords: Endoscopy, Oesophagus, Rehabilitation medicine, Gastrointestinal surgery

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          Abstract

          A man in his late 50s presented with severe dysphagia caused by a complex refractory benign stenosis that was completely obstructing the middle oesophagus. The patient was unsatisfied with the gastrostomy tube placed via laparotomy as a long-term solution. Therefore, we performed robot-assisted minimally invasive oesophagectomy (video). Mobilisation of the stomach and gastric conduit preparation were more difficult due to the previously inserted gastrostomy tube; thus, the conduit blood supply was assessed using indocyanine green fluorescence. After an uncomplicated course, the patient was referred directly to inpatient rehabilitation on the 16th postoperative day. At 9 months after surgery, the motivated patient returned to full-time work and achieved level 7 on the functional oral intake scale (total oral diet, with no restrictions). At the 1-year follow-up, he positively confirmed all nine key elements of a good quality of life after oesophagectomy.

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          Most cited references18

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          Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients.

          Michael A Crary, Giselle D Carnaby Mann, Michael E Groher (2005)
          To report on the development and psychometric evaluation of a clinical scale to document change in functional oral intake of food and liquid in stroke patients. Validity and reliability study. Tertiary care, academic medical center, metropolitan stroke unit. Acute stroke patients (N=302). Not applicable. Interrater reliability, validity, and sensitivity to change assessments were completed on a 7-point ordinal scale-the Functional Oral Intake Scale (FOIS)-developed to document the functional level of oral intake of food and liquid in stroke patients. Interrater reliability was drawn from FOIS ratings applied to dietary information from patient medical charts. Consensual validity was estimated by rankings from judges against predefined scale scores. Criterion validity was evaluated by comparison to the Modified Rankin Scale, the Modified Barthel Index, and Mann Assessment of Swallowing Ability. Cross-validation was assessed via comparison to 2 physiologic measures of swallowing function. Change in functional oral intake over time was assessed descriptively by applying the scale to dietary information from a cohort of 302 acute stroke patients followed up for 6 months. Interrater reliability was high, with perfect agreement on 85% of ratings. Kappa statistics ranged from .86 to .91. Consensual validity was high (.90). Criterion validity was high at onset and 1 month poststroke. Significant associations were identified between the FOIS and stroke handicap scales. The FOIS was significantly associated with 2 physiologic measures of swallowing. Scores on the FOIS from the cohort of stroke patients showed a shift toward increased oral intake over a 6-month period. The FOIS had adequate reliability, validity, and sensitivity to change in functional oral intake. These findings suggest that the FOIS may be appropriate for estimating and documenting change in the functional eating abilities of stroke patients over time.
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            Outcomes after minimally invasive esophagectomy: review of over 1000 patients.

            Ghulam Abbas, Arjun Pennathur, H S Keeley … (2012)
            Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.
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              Refractory Esophageal Strictures: What To Do When Dilation Fails

              Petra G A van Boeckel, Peter D Siersema (2015)
              Opinion statement Benign esophageal strictures arise from a diversity of causes, for example esophagogastric reflux, esophageal resection, radiation therapy, ablative therapy, or the ingestion of a corrosive substance. Most strictures can be treated successfully with endoscopic dilation using bougies or balloons, with only a few complications. Nonetheless, approximately one third of patients develop recurrent symptoms after dilation within the first year. The majority of these patients are managed with repeat dilations, depending on their complexity. Dilation combined with intra lesional steroid injections can be considered for peptic strictures, while incisional therapy has been demonstrated to be effective for Schatzki rings and anastomotic strictures. When these therapeutic options do not resolve the stenosis, stent placement should be considered. Self bougienage can be proposed to a selected group of patients with a proximal stenosis. As a final step surgery is an option, but even then the risk of stricture formation at the anastomotic site remains. This chapter reviews refractory benign esophageal strictures and the treatment options that are currently available.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Case Rep
                Journal ID (iso-abbrev): BMJ Case Rep
                Journal ID (hwp): bmjcr
                Journal ID (publisher-id): bmjcasereports
                Title: BMJ Case Reports
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 1757-790X
                Publication date Collection: 2024
                Publication date (Electronic): 2 May 2024
                Publication date PMC-release: 2 May 2024
                Volume: 17
                Issue: 5
                Electronic Location Identifier: e256455
                Affiliations
                [1 ] departmentGeneral and Visceral Surgery , St. Georg Hospital Eisenach , Eisenach, Germany
                [2 ] departmentGeneral-, Visceral- and Thoracic Surgery , Ringgold_9143Klinikum Darmstadt , Darmstadt, Germany
                Author notes
                [Correspondence to ] Professor Werner Kneist; w.kneist@ 123456t-online.de
                Author information
                http://orcid.org/0000-0002-7219-0523
                Article
                Publisher ID: bcr-2023-256455
                DOI: 10.1136/bcr-2023-256455
                PMC ID: 11085858
                PubMed ID: 38697681
                SO-VID: 45989266-4258-4500-a3f4-26104a4e0278
                Copyright © © BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 06 April 2024
                Categories
                Subject: Case Reports: Rare disease
                Subject: 1506
                Subject: 1523
                Custom metadata
                special-feature unlocked

                Keywords: endoscopy,oesophagus,rehabilitation medicine,gastrointestinal surgery
                Data availability:
                Keywords: endoscopy, oesophagus, rehabilitation medicine, gastrointestinal surgery

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