SPONTANEOUS RUPTURE OF THE RIGHT CONGENITAL DIAPHRAGMATIC EVENTRATION ON THE RIGHT SUBJECTED TO SURGICAL CORRECTION IN A CHILD WITH MEGADOLICOCOLON

Спонтанний розрив гемідіафрагми у випадках вродженої діафрагмальної евентрації зустрічається вкрай рідко, у літературі повідомляють про унікальні випадки.In this context, the authors present the case of an 8-year-old child who was hospitalized in the coloproctology service for abdominal pain, lack of stool for more than 7 days, pronounced abdominal distension. The child suffers from Down's disease. In 2017, he was occasionally diagnosed with right diaphragmatic eventration and underwent surgical correction by thoracic approach. After a thorough evaluation, with signs suggestive of diaphragmatic hernia on the right, the child underwent surgery, intraoperatively the rupture of the right hemidiaphragm was found with intrathoracic ascension of the malrotated intestinal loops, transverse colon and omentum. The repair of the diaphragmatic eventration complicated by rupture was used using the “overcoat” folding procedure, on the suture line being carefully applied a collagen foil covered with components of the fibrin adhesive. The postoperative period passed without complications.Conclusion. Spontaneous rupture of the diaphragm is a rare complication in children with diaphragmatic eventration, especially on the right side, in this case obstruction of the malformative colon ascended intrathoracically with progressive dilation of the intestinal loops being responsible for distension with gradual thinning of the hemidiaphragm sac resulting malformation in diaphragmatic rupture with herniation and progressive obliteration of the pleural space. The case of rupture of the diaphragmatic eventration associated with megadolicocolon confirms that the respiratory symptoms characteristic of this clinical situation may be overshadowed by the predominance of signs of intestinal obstruction, without leading to sudden progressive clinical deterioration, which proved to be a misleading moment in diagnosis. certainty of this serious complication rarity.

Complications After Lymph Node Dissection Along Bilateral Recurrent Laryngeal Nerves Through Right Thoracic Approach in the Patients With Thoracic Esophageal Cancer

Background: Extensive lymph nodes dissection can improve the accuracy of tumor staging and prognosis of the patients with thoracic esophageal cancer, palsy of recurrent laryngeal nerve (RLN) caused by the lymph node (LN) dissection along RLN chain also increase postoperative complications and may affect the prognosis. This study aimed to evaluate the associated postoperative complications after LN dissection along RLNs in the patients with thoracic esophageal squamous cell cancer (ESCC).Methods: 339 eligible patients with thoracic ESCC who underwent radical McKeown or Ivor-Lewis esophagectomy by open or VATS procedures through right thoracic approach with LN dissection along bilateral RLNs were included in this study. Univariate and multivariate logistic regression analysis were conducted to assess the correlation of RLN paralysis (RLNP) with other post-operative complications. Results: 39 of the 339 patients were diagnosed with RLNP (11.5%) postoperatively. The incidence of RLNP in three-field (3FL) LN dissection was significantly higher than that in the two-field (2FL) LN dissection ( 24.0% vs 8.0%, P＜0.001). Compared with the patients without RLNP, the patients with it had a significantly higher incidence of postoperative anastomotic leakage (P=0.029), pulmonary complications (P=0.001) and much longer hospital stay (P=0.001). Two patients died of respiratory failure within 30 days caused by RLNP and were treated by reintubation. Conclusion: RLNP after LN dissection along bilateral RLN in thoracic ESCC was associated with much higher morbidity such as pulmonary complications, anastomotic leakage, and much longer hospital stay. New technologies are required to reduce RLNP incidence and its associated complications.

285 RIGHT COMPARED WITH LEFT THORACIC APPROACH ESOPHAGECTOMY FOR PATIENTS WITH MIDDLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA

The open surgical approaches for esophageal cancer (EC) can be mainly divided into the right and left transthoracic approach in China. Although it shows an increasing number of right side approach, the optimal surgical technique remains unclear. This study attempt to compare the long-term survival between two approaches in a large cancer center with rich experience of both side transthoracic approach. Methods The patients who underwent right transthoracic approach esophagectomy (Right, McKeown) and left transthoracic approach esophagectomy (Left, Sweet or chest neck dual-incision) for esophageal squamous cell carcinoma (ESCC) during January 2015 to January 2018 were included. The overall survival (OS) rate and perioperative data between two groups were retrospectively analysed. Results We included 437 patients who underwent Right (n = 202) or Left (n = 235) approach for ESCC. There was a significantly longer median operative time (250 min vs. 190 min, P < 0.001) and longer median postoperative hospital stady days (17 days vs. 14 days, P < 0.001) in Right groups. The OS at 34-months was 69.83% and 67.32% in Right and Left groups, respectively; hazard ratio (HR) (95% CI): 1.121 (0.723–1.737), p = 0.611. Conclusion For middle thoracic ESCC without suspected lymph node metastasis in the upper mediastinum, the esophagectomy through left thoracic approach could achieve the same OS with right side, and better short-term outcomes.

Diagnostic and therapeutic management of hydrothorax in peritoneal dialysis

Hydrothorax is a rare mechanical complication of peritoneal dialysis (PD) which often results in discontinuation of the technique. According to studies, its incidence is estimated at 1.6 to 2%. In the majority of cases, its location is on the right. It is secondary to the passage of dialysate from the peritoneal cavity to the pleural space through a diaphragmatic breach, which may be acquired or congenital. The additional tests necessary to confirm the diagnosis are often invasive and expensive, and are not the subject of any consensus. It is the same for the therapeutic management, which goes from the simple transient interruption of the dialysis to heavy treatments such as thoracotomy. In our center, we have opted to simplify the management of patients with hydrothorax. From a diagnostic standpoint, we use simple, minimally invasive and less expensive examinations. For the therapeutic management, we have opted, since our first case in 2000, for a simple and less aggressive surgical technique, with an abdominal and non-thoracic approach allowing the installation of a sub-diaphragmatic prosthesis by laparoscopic route to seal the lesions breaches. Out of 10 operated patients, 2 (20%) presented with a relapse of hydrothorax and were permanently transferred to hemodialysis. The remaining 8 (80%) were able to resume PD without subsequent recurrence or complications, after a 3- to 4-week PD interruption period during which all patients were hemodialyzed through a simple central catheter.

Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

Introduction: Substernal goiter is usually defined as a goiter that extends below the thoracic inlet or a goiter with more than 50% of its mass lying below the thoracic inlet. Substernal goiters may compress adjacent anatomical structures causing a variety of symptoms. Case report: Here we report a rare case of a 75-year-old woman presenting with cardiac arrest caused by acute respiratory failure due to tracheal compression by a substernal goiter. Discussion: Substernal goiters can be classified as primary or secondary depending on their site of origin. Symptoms are diverse and include a palpable neck mass, mild dyspnea to asphyxia, dysphagia, dysphonia, and superior vena cava syndrome. Diagnosis of substernal goiter is largely based on computed tomography imaging, which will show the location of the goiter and its extension in the thoracic cavity. Surgery is the treatment of choice for symptomatic patients with substernal goiter. The majority of substernal goiters are resected through a cervical approach. However, in approximately 5% of patients, a thoracic approach is required. The most important factor determining whether a thoracic approach should be used is the depth of the extension to the tracheal bifurcation on CT imaging. Conclusion: Cardiac arrest appearing as the first symptom of a substernal goiter is a very rare condition and should be treated by emergency thyroidectomy via a cervical or thoracic approach depending on the CT imaging findings.