The essence of augmentation is the gradual gradual expansion of the lumen at the site of narrowing of the esophagus due to the rupture of the cicatricial rings. 3-4 boujas are usually performed in one session. The basic bougie course consists of 5-10 sessions, followed by supportive procedures. There are endoscopic bougie and bougie under X-ray control. In the second case, surgeons perform the procedure in the X-ray room. One of the disadvantages is radiation exposure, the interventions must be repeated many times (the expansion does not occur in one session). In this case, the procedure is performed, as a rule, in a standing position, and this is problematic during sedation, so most often the patient undergoes endoscopic augmentation without X-rays.
In EMC, Savary bougie is used to augment the esophagus. They are made of polyvinyl chloride, quite flexible, are radiopaque, and have two markings that are visible on the X-ray.
During this type of esophageal augmentation, the patient lies on his side, and an endoscope is inserted into the stomach through the mouth. The procedure can be performed either under local anesthesia or under intravenous sedation. The EMC uses the most comfortable method – local short-term anesthesia using ultrashort drugs in small dosages, it is very popular in the USA and Europe. Thanks to this method, the augmentation procedure is safe and painless. At the EMC, sedation is performed by a highly qualified team of anesthesiologists. The whole procedure takes about 1 hour.
EMC has high-precision Japanese endoscopes that can distinguish even minor changes in the structure of tissues. They have a double-focus system, so the doctor can examine the mucosa in a large approximation for a correct assessment of the dimpled and vascular pattern.
Due to the narrowing of the esophageal lumen during augmentation, endoscopes with a small diameter of 5-6 mm are often used. A guiding string, a metal conductor with a spring at the end, is passed through the instrumental channel of the endoscope under visual control into the stomach or duodenum. If none of the endoscopes passes through the constriction, then the string into the stomach is carried out under the control of the upper edge of the constriction, and in this case a soft biliary string is used. Such a string is less traumatic, which reduces the risk of perforation of the esophagus or the formation of a false passage.
With very complex convoluted strictures, it is at this stage that X-ray monitoring of the string position and the direction of its passage during bougie may be required. After the string is inserted into the stomach, the endoscope is removed and the string remains. 3-4 boughs of increasing diameter are carried along it, as if on rails, after which the string is extracted along with the last bougie. Exposure is not required in this case.
The procedures are repeated with an interval of 1-3 days. The number of sessions depends on the severity of the initial narrowing, its localization, extent, density (rigidity), causes, the tendency of tissues to develop restenosis, refractory stricture (lack of adequate response to the use of standard bougie schemes) and many other factors. In a standard situation, the basic course consists of 5-10 sessions, they are performed with an interval of 1-3 days.
Next, a long course of supportive bougie begins with a gradual increase in the intervals between interventions, starting from one week to a month to prevent restenosis. In general, the process of endoscopic treatment of esophageal anastomosis strictures takes from 6 months to 1 year, and esophageal strictures – from 1 year to 2 years.
The removal of the rectum in a robot-assisted manner is an operation using a high–tech Da Vinci robot. High-resolution optics allows the surgeon to see the rectum and other organs in multiple magnification and perform extirpation with high precision.
At EMC, surgeons have extensive experience in performing nerve-sparing extirpations and have all modern technologies for dissecting (dissecting) the necessary tissues without damage. The surgeon has a Harmonic ultrasonic scalpel in his arsenal, which allows him to isolate tissue structures very subtly and accurately and not harm them. As a result of this approach, the patient will be able to avoid complications in the early postoperative period (urinary disorders, erectile dysfunction, pelvic organ dysfunction).
After oesophageal augmentation, the patient does not need time for rehabilitation. It is advisable not to be alone (unaccompanied) outside the house during the first 12 hours (for example, in the subway, shops or on the street), and also not to drive a vehicle yourself.
Within an hour after the intervention, a person can take food and liquids. Important: food should not be hot, spicy, smoked, or pickled. He is also prescribed pumpkin or olive oil, if necessary, antacids and antisecretory drugs. In some cases, the administration of analgesics may be required in the first hours after bougie. Otherwise, the patient leads a habitual lifestyle immediately after the procedure, bed rest due to bougie is not required.
