Esophageal stricture surgery: Difference between revisions
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<br> | <br>In most patients, surgery is the last treatment resort, as it is technically difficult and may lead to serious morbidity and mortality. Surgery usually requires opening the thorax and possibly the abdomen, depending upon the location of the stricture. Generally, patients with refractory strictures located in the more distal esophagus are technically easier to operate and resect, and there is more esophagus available proximal to the stricture. From the surgeon's technical perspective, strictures in the midesophagus, and certainly the proximal esophagus, are more difficult to operate, as they can be intimately involved with the airway. | ||
<ref name="pmid21346853">{{cite journal |vauthors=Baron TH |title=Management of benign esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=1 |pages=46–9 |year=2011 |pmid=21346853 |pmc=3038317 |doi= |url=}}</ref> | |||
In the case of a malignant stricture, surgery is usually reserved for strictures that are resectable, as palliative resection is rarely performed with the advent of esopha-geal stents. For benign strictures, surgery is reserved for patients with associated chronic fistulae and strictures that are refractory to esophageal dilation and stenting. | |||
<ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref> | |||
Antral patch esophagoplasty is a new procedure for intractable fibrous stricture of the esophagus secondary to acid-peptic reflux. A full-thickness patch of gastric antrum, supplied by a pedicle based on the left gastroepiploic vessels, is inserted, mucosal surface to lumen, into the opened stricture. A fundoplication is done below the esophagoplasty to prevent reflux. The functional results were excellent in five of six patients. The procedure may have application also in other types of benign esophageal stricture.<ref name="pmid426179">{{cite journal |vauthors=Hugh TB, Lusby RJ, Coleman MJ |title=Antral patch esophagoplasty. A new procedure for acid-peptic esophageal stricture |journal=Am. J. Surg. |volume=137 |issue=2 |pages=221–5 |year=1979 |pmid=426179 |doi= |url=}}</ref> | |||
The presence and severity of injuries are correlated with the amount of caustic substances ingested. Surgical treatment is a good option in patients with severe strictures, and colonic interposition might be the best surgical process. The most important factors to guarantee a successful outcome for surgery are good vascular supply and absence of tension in the anastomosis.<ref name="pmid15334683">{{cite journal |vauthors=Han Y, Cheng QS, Li XF, Wang XP |title=Surgical management of esophageal strictures after caustic burns: a 30 years of experience |journal=World J. Gastroenterol. |volume=10 |issue=19 |pages=2846–9 |year=2004 |pmid=15334683 |pmc=4572115 |doi= |url=}}</ref> | |||
==Indications for surgery<ref>{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref> == | ==Indications for surgery<ref>{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref> == | ||
Revision as of 16:27, 8 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]
Overview
The mainstay of treatment for esophageal stricture is dilation. Proton pump inhibitors or H2 antagonists are recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Self-expandable plastic or metal stents placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of dysphagia, extraesophageal manifestations and long term side effects of medical therapy
Surgery
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- Pharyngoesophageal puncture in severe upper esophageal stenosis after radiation therapy for laryngeal and hypopharyngeal cancers [1].
- Esophageal surgical resection via colonic interposition between cervical esophagus and duodenum or stomach [2]
- Patients with undilatable strictures, are candidates for transhiatal esophageal resection with replacement by either stomach, colon or jejunum. Laparoscopic esophagectomy is now routinely performed in a few centers, however, evidence of superior outcomes as compared to open surgery is still pending.[3]
In most patients, surgery is the last treatment resort, as it is technically difficult and may lead to serious morbidity and mortality. Surgery usually requires opening the thorax and possibly the abdomen, depending upon the location of the stricture. Generally, patients with refractory strictures located in the more distal esophagus are technically easier to operate and resect, and there is more esophagus available proximal to the stricture. From the surgeon's technical perspective, strictures in the midesophagus, and certainly the proximal esophagus, are more difficult to operate, as they can be intimately involved with the airway.
In the case of a malignant stricture, surgery is usually reserved for strictures that are resectable, as palliative resection is rarely performed with the advent of esopha-geal stents. For benign strictures, surgery is reserved for patients with associated chronic fistulae and strictures that are refractory to esophageal dilation and stenting. [5]
Antral patch esophagoplasty is a new procedure for intractable fibrous stricture of the esophagus secondary to acid-peptic reflux. A full-thickness patch of gastric antrum, supplied by a pedicle based on the left gastroepiploic vessels, is inserted, mucosal surface to lumen, into the opened stricture. A fundoplication is done below the esophagoplasty to prevent reflux. The functional results were excellent in five of six patients. The procedure may have application also in other types of benign esophageal stricture.[6]
The presence and severity of injuries are correlated with the amount of caustic substances ingested. Surgical treatment is a good option in patients with severe strictures, and colonic interposition might be the best surgical process. The most important factors to guarantee a successful outcome for surgery are good vascular supply and absence of tension in the anastomosis.[7]
Indications for surgery[8]
- Inability to dilate the stricture
- Frequent recurrence of dysphagia
- Esophagitis refractory to medical therapy
- Extraesophageal manifestations such as aspiration pneumonia
- Long term side effects of medical therapy in young patients.
References
- ↑ Tang SJ, Singh S, Truelson JM (2010). "Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos)". Surg Endosc. 24 (1): 210–4. doi:10.1007/s00464-009-0535-y. PMID 19517185.
- ↑ Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.
- ↑ Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.
- ↑ Baron TH (2011). "Management of benign esophageal strictures". Gastroenterol Hepatol (N Y). 7 (1): 46–9. PMC 3038317. PMID 21346853.
- ↑ Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
- ↑ Hugh TB, Lusby RJ, Coleman MJ (1979). "Antral patch esophagoplasty. A new procedure for acid-peptic esophageal stricture". Am. J. Surg. 137 (2): 221–5. PMID 426179.
- ↑ Han Y, Cheng QS, Li XF, Wang XP (2004). "Surgical management of esophageal strictures after caustic burns: a 30 years of experience". World J. Gastroenterol. 10 (19): 2846–9. PMC 4572115. PMID 15334683.
- ↑ Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.