Application of minimally invasive technologies in the treatment of combat trauma of the esophagus

Background. The purpose was to evaluate the effectiveness of minimally invasive technologies in the treatment of combat trauma of the esophagus. Materials and methods. Seventeen patients with combat injuries of the esophagus were treated in the surgical clinic of the Military Medical Clinical Center of the Northern Region of the Medical Forces Command of the Armed Forces of Ukraine. Their average age was 20.1 ± 3.4 (range 26–56) years. The average time from injury to surgical treatment was 11.8 (range 3–48) hours. Median Injury Severity Score was 6.8 (range 4–13). Fifteen (88.2 %) patients had penetrating gunshot wounds, 1 (5.9 %) individual had an explosive injury with a wound to the thoracic part of the esophagus, and another one (5.9 %) had a stab wound to the chest with damage to the esophagus. Combat trauma of the esophagus as an isolated injury caused by a penetrating gunshot wound was extremely rare — in 1 (5.9 %) case. When dividing by the location, damage to the cervical portion of the esophagus was noted in 10 (58.8 %) people, thoracic — in 5 (29.4 %), abdominal part of the esophagus — in 2 (11.8 %) cases. By the number of accompanying injuries, 1 (6 %) patient had 3 or more combined injuries, 11 (65 %) — 2 combined injuries, 5 (29 %) had isolated injuries. By the nature of the damage to the esophagus, 5 (29 %) individuals had a penetrating, 3 (18 %) — non-penetrating, 9 (53 %) — tangential injury. In terms of severity, 3 (17.6 %) patients had injuries of grade ІІ according to the American Association for the Surgery of Trauma (AAST) classification, 15 (88.2 %) — of grade І. The effectiveness of surgical treatments for combat injuries of the esophagus with the use of minimally invasive (videoendoscopic) methods, the length of hospital stay, and the terms of restoring the integrity of the esophagus were evaluated. Results. One (5.9 %) patient with a wound of the thoracic part of the esophagus after an explosive injury was treated non-operatively with a control computed tomography esophagography on day 5 day. Ten (58.8 %) patients with an injury to the cervical part of the esophagus and 1 (5.9 %) with an injury to the upper thoracic part of the esophagus underwent colotomy with wound debridement, repair with double-row suture and reinforcement of the site of damage to the cervical part of the esophagus with the help of m. sternocleidomastoideus. One (5.9 %) patient with an injury to the abdominal part of the esophagus had laparotomy due to injury to accompanying organs, in 4 (23.5 %) cases, video endoscopic treatment methods were used, in 3 (17.6 %) of them — video thoracoscopy with suturing of the esophageal wound, and 1 (5.9 %) underwent video laparoscopy. The average term of inpatient treatment was 19.0 ± 3.9 (range 10–35) bed-days, median healing of esophageal wounds using video endoscopic techniques was 6 days. Conclusions. In victims with penetrating wounds of the neck, chest and abdomen, in whom there is a suspicion of damage to the esophagus, routine multispiral computed tomography of the neck, chest and abdominal organs with contrast enhancement, esophagography, endoscopy, and the method of “double” intraoperative endoscopy are recommended. Early diagnosis of esophageal injuries using minimally invasive video endoscopic technologies in hemodynamically stable patients with Injury Severity Score < 9 points and mild injuries of grade 1–2 according to the AAST classification is an adequate method of treatment for esophageal injuries with high clinical effectiveness, which allows to reduce the risk of complications and disability.