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THE PHYSICAL AND MATHEMATICAL MODEL OF INTRATHORACIC STOMACH USED FOR ESOPHAGOGASTROPLASTY: II. THE STOMACH TRANSPLANT WIDTH AND PYLORIC DRAINAGE PROCEDURE IMPACT ON GASTRIC EMPTYING TIME

Authors: Vynnychenko O.I.

Pages: 109-117

Abstract

Introduction. There are limited data concerning food transportation through the intrathoracic stomach used for esophageal replacement after resection. Bilateral truncal vagotomy and partial sympathectomy make the stomach transplant act as an inert tube; although, food moves only by gravitation force there.

Purpose. After previous application of the basic physical and mathematical model of the intrathoracic stomach, I assumed that further assessment of the gastroplasty model width and diameter of pyloric canal should be performed.

Materials and methods. The gastric tube models with the three different diameters of 30 mm (prototype is narrow gastric tube); 60 mm (prototype – wide gastric tube) and 90 mm (prototype – the whole stomach) were produced and connected to the three variants of pyloric canal model (3.5 mm vs 7.0 mm vs 14.0 mm). I calculated the transportation time through physical models for 250 ml of water and 50 % glycerin. I analyzed either additional negative chest pressure and positive intraabdominal pressure had effect on the liquids emptying time.

Results. The obtained results showed thatthetimeperiods ofwater emptying for 90 mm gastric tube were 63.3 ± 2.0;15.0 ± 1.3 and 3.4 ± 1.0 seconds for 3.5 mm; 7.0 mm and 14 mm pyloric canal models respectively; the time periods of water emptying for60 mm gastric tube were 38.8 ± 1.1; 9.8 ± 0.8 and 2.4 ± 0.8 seconds for 3.5 mm; 7.0 mm and 14 mm pyloric canal models respectively; and the time periods of water emptying for30 mm gastric tube were 19.7 ± 2.1; 5.3 ± 1.9 and 1.3 ± 0.8 seconds for 3.5 mm; 7.0 mm and 14 mm pyloric canal models respectively. The term of glycerin transportation was significantly higher comparing with water transportation through the model (3.2–3.4 odd). Additional negative chest pressure and positive intraabdominal pressure had no effect on the liquids evacuation time.

Discussion: Emptying time equation for intrathoracic stomach model was calculated and compared with data obtained from physical model exploration. I assumed that the width stomach transplant defined the emptying time regardless fluid consistency. I emphasized on the necessity of wide gastric tube esophageal replacement and digital pyloric rupture at clinical setting.

   Key words esophagogastroplasty, the modeling of intrathoracic stomach, stomach transplant width, emptying time equation.

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References

 

  1. D'Journo XB, Martin J, Ferraro P, Duranceau A.The esophageal remnant after gastric interposition. . 2008;21:377–388.doi: 10.1111/j.1442-2050.2008.00849.x
  2. Donington JS. Functional conduit disorders after esophagectomy. Thorac. Surg. Clin. 2006;16(1):53–62.
  3. Nakabayashi T, Mochiki E, Kamiyama Y, Kuwano H. Gastric motor activity in gastric pull-up esophagectomized patients with and without reflux symptoms. Ann. Thorac. Surg. 2012;94:1114–1117.
  4. Jain V, Sharma S, Kumar R, Kabra SK, Bhatia V, Gupta DK. Transposed intrathoracic stomach: functional evaluation. Afr. J. Paediatr. Surg. 2012;99(3):210.
  5. Martin L, Lagergren J, Lindblad M, Rouvelas I, Lagergren P. Malnutrition after oesophageal cancer surgery in Sweden. Br J Surg. 2007;94(12):1496–500.
  6. Deng B, Tan QY, Jiang YG, Zhao YP, Zhou JH, Chen GC, Wang RW. Prevention of early delayed gastric emptying after high-level esophagogastrostomy by "pyloric digital fracture". World J. Surg. 2010;34(12):2837–2843.doi: 10.1007/s00268-010-0766-z
  7. Vynnychenko O.I. [The physical and mathematical model of intrathoracic stomach used for esophagogastroplasty: basic principles and method of mathematic modeling]. Journal of Clinical and Experimental Medical Research. 2013;1(3):347–353.
  8. Prithard PJ. Fox and McDonald’s introduction to fluid mechanics. Hoboken: John Wiley and Sons Inc., 2011, 899 p.
  9. Fu JH. [Reconstruction of esophagus with-gastric tube: view from anatomical physiology]. Zhonghua Wei Chang Wai Ke Za Zhi. 2008;11(1):8–10.
  10. Gutschow C, Collard JM, Romagnoli R, Salizzoni M, Hölscher A. Denervated stomach as an esophageal substitute recovers intraluminal acidity with time. Ann. Surg. 2001;233(4):509–514.
  11. Ndoye JM, Dia A, Ndiaye A, Fall B, Diop M, Ndiaye A, Sow ML. Arteriography of three models  of gastric oesophagoplasty: the whole stomach, a wide gastric tube and a narrow gastric tube. Surg. Radiol. Anat. 2006;28(5):429–437.
  12. Samoylov PV. [Changes of mediastinum organs topography after the resection of the esophagus with plastic of the gastric transplantat (operation of the type Lewis) in the remote period after surgery]. FundamentalResearch. 2013;5:135–138.                                  
  13. Palmes D, Weilinghoff M, Colombo-Benkmann M, Senninger N, Bruewer M. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch. Surg. 2007;392:135–141.
  14. Velanovich V. Esophagogastrectomy without pyloroplasty. Dis. Esophagus. 2003;16:243–245.
  15. Yuasa N, Sasaki E, Ikeyama T, Miyake H, Nimura Y. Acid and duo-denogastroesophageal reflux after esophagectomy with gastric tube reconstruction. Am. J. Gastroenterol. 2005;100(5):1021
  16. Rice TW. Anastomotic stricture complicating esophagectomy. Thorac. Surg. Clin. 2006;16(1):63–73
  17. Zhang C, Wu QC, Hou PY, Zhang M, Li Q, Jiang YJ, Chen D. Impact of the method of reconstruction after oncologic oesophagectomy on quality of life – a prospective, randomised study. European Journal of Cardio-thoracic Surgery. 2011;39:109–114.