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J Thorac Cardiovasc Surg 1998;115:1241-1245
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

Esophageal replacement for end-stage benign esophageal disease

From the Division of Cardiothoracic Surgery and Department of Surgery, University of Rochester, Rochester, N.Y.,^a and Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.^b

Read at the Twenty-third Annual Meeting of The Western Thoracic Surgical Association, Napa, Calif., June 25-28, 1997.

Received for publication July 8, 1997 Revisions requested Sept. 2, 1997; revisions received Oct. 17, 1997. Accepted for publication Jan. 15, 1998. Address for reprints: Tom R. DeMeester, MD, Department of Surgery, University of California School of Medicine, 1510 San Pablo St., Suite 514, Los Angeles, CA 90033-4612.

Background: Benign esophageal diseases constitute a common group of disorders that are generally managed with medical therapy or surgery designed to improve foregut function. A small subset of patients, however, has advanced disease that requires esophageal replacement to achieve symptomatic relief.
Patients and methods: One hundred four patients with benign esophageal disease who underwent esophageal reconstruction over a 21-year period (1975 to 1996) were reviewed retrospectively. Dysphagia was the major symptom driving surgery in 80% of the patients. Colon was used to reconstruct the esophagus in 85 patients; stomach, in 10 patients; and jejunum, in 9 patients. Forty-two patients who had lived with their reconstruction for 1 year or more answered a postoperative questionnaire concerning their long-term functional outcome.
Results: In the 104 patients, the primary underlying abnormality leading to esophageal replacement was end-stage gastroesophageal reflux (37 patients), an advanced motility disorder (37 patients), traumatic, iatrogenic or spontaneous perforation (15 patients), corrosive injury (8 patients), congenital abnormality (6 patients), or extensive leiomyoma (1 patient). Ninety-eight percent of patients reported that the operation had cured or improved the symptom driving surgery. Ninety-three percent were satisfied with the outcome of the operation. The overall hospital mortality rate was 2%, and the median hospital stay was 17 days. Graft necrosis occurred in 3% of patients, and anastomotic leak occurred in 6% of patients (or 2% of the total number of anastomoses).
Conclusions: Esophageal replacement for benign disease can be accomplished with a low mortality rate and a marked improvement in alimentation. Reconstruction restores the pleasure of eating and is viewed by the patient to be highly successful.

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