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Objectives: We aim to optimize surgical strategy to decrease relapse of tubercular abscess in the chest wall (TACW)., Methods: The records of 120 patients who underwent surgical treatment for TACW from May 2005 to March 2011 were retrospectively reviewed. We conducted the following surgical treatment as '6C + A' by abbreviating the first alphabet of each step: (i) careful exploration of the abscess; (ii) complete resection; (iii) cavity washing using sodium bicarbonate solution; (iv) coverage using muscle flap; (v) continuous suction and drainage; (vi) compression dressing and (vii) anti-tuberculosis medication., Results: One hundred and thirteen cases were discharged for rehabilitation with the first stage wound healing (113/120). Four cases postoperatively suffered from subcutaneous fistula which was healed after dressing changes for 1-2 months. Three patients with an abscess relapse underwent the second operation 2 months after the first operation. Follow-ups ranged from 2 months to 6 years and demonstrated no recurrence., Conclusions: We deem the surgical procedures '6C + A' effective to obviate relapse of TACW.

Objectives: The decision to proceed to simple underwater seal drainage or to apply active suction to the underwater seal following pulmonary operation is a controversial one. For the sake of selecting the alternative to reduce postoperative air leakage, we performed a meta-analysis of randomised controlled trials (RCTs) to determine the benefit of suction or non-suction following lung surgery on patient outcomes., Methods: RCTs published in English from 1999 to 2009 were included. A fixed-effect model was developed for postoperative pneumothorax cases. A random-effects model was developed for quantitative data synthesis, including prolonged air-leak cases, duration of air leakage, time for the removal of chest tubes and hospital stay., Results: Odds ratio (95% confidence interval (CI)), expressed as suction versus non-suction, was 0.11 (0.03-0.49) for postoperative pneumothorax cases; relative risk was 1.48 (0.82-2.70) for prolonged air-leakage cases; weighted mean difference was 1.16 (-0.63 to 2.94) for the duration of air leakage, 0.96 (-0.12 to 2.05) for the time for removal of chest tubes and 2.19 (0.61-4.98) for the hospital stay., Conclusion: There is no necessity to use suction in most cases, since it cannot decrease the incidence of prolonged air leak. However, suction can reduce the occurrence of postoperative pneumothorax resulting from early air leak. As a result, the early use of postoperative suction might be crucial to specific patients to whom early elimination of residual space is very important., (Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Objective: In the study, we made the pharyngoesophageal functional assessment and menometric study on the two kinds of anastomosis (traditional hand-sewn anastomosis and side-to-side stapled anastomosis) for the further evaluation and application of cervical esophagogastrostomy., Patients: The study included 17 patients with esophageal squamous cancer from March 2006 to May 2008. Eight patients had undergone total esophagectomy and traditional hand-sewn technique in CEGA. The other nine patients had undergone total esophagectomy and side-to-side stapled technique in CEGA. All the 17 patients were studied for 3 months after the operations. The complete data, such as esophagogastroscopy, barium swallow and manometric studies, were obtained for each participating patient., Results: In the hand-sewn group of eight patients, four patients (50%) reported clinical significant symptoms of cervical dysphagia. Two patients (11.1%) reported clinical significant symptoms of cervical dysphagia in the side-to-side group of nine patients. There is a statistically significant difference between the hand-sewn group of patients (n=8) and the side-to-side group of patients (n=9) with respect to overall mean anastomotic diameters (1.688+/-0.26 cm vs 3.012+/-0.17 cm, p=2.10 x 10(-8)). In the eight patients who underwent hand-sewn technique, there were four symptomatic patients with poor menometric datum, such as anastomotic hypertensive peristaltic activity, confusing inversion of anastomotic and midcervical esophageal pressure, and consequently poor compliance of the pharyngoesophageal segment (pharyngeal shoulder pressure). By contrast, there was only one symptomatic patient with poor menometric data in the nine patients who underwent side-to-side technique., Conclusion: The side-to-side stapled technique is conducive to decrease complications of postoperative dysphagia and is helpful for improving pharyngesophageal and anastomotic menometric function. The anastomotic technique deserves more attention and further applications.

Objective: We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns., Methods: Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation., Results: There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux., Conclusion: The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.