The Journal of Thoracic and Cardiovascular Surgery, Vol 72, 512-517, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Preoperative assessment of esophageal pathology
RD Henderson and FG Pearson
Panmural esophagitis results in esophageal thickening and shortening and
prevents adequate reduction of a hernia. Twenty patients with panmural
esophagitis, treated by Belsey repair, have been followed up for more than
5 years; 9 of them remain asymptomatic and 11 have symptomatic reflux, 7 of
whom have required further surgery. Belsey also has reported a 45 per cent
recurrence rate in patients with this type of disease. Preoperative
recognition of panmural esophagitis allows a planned surgical approach and
the use of a surgical technique designed for the management of an
irreducible hernia. The ability to predict these changes was studied in 124
patients, who were evaluated by history, radiology, endoscopy, and
manometry prior to transthoracic hernia repair. The esophagus was inspected
at operation to determine the presence of panmural changes. History was of
no value in assessment. Radiologically, a large and irreducible hernia was
associated with panmural changes, but these changes also occurred in the
absence of ulceration. Manometric studies allowed accurate prediction of
mural changes. Over 90 per cent of patients with panmural esophagitis have
more than 40 per cent disordered motor activity (DMA) in the distal part of
the esophagus, and 75 per cent of such patients have more than 60 per cent
DMA. Combining these investigative data allowed the accurate prediction of
panmural changes in 90 per cent of the 124 patients.
