The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 182-188, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Surgery for benign esophageal stricture
DJ Keenan, JR Hamilton, J Gibbons and HM Stevenson
The long-term results of five different operations for benign lower
esophageal reflux stricture, carried out over the 5 year period 1973 to
1977, are presented and evaluated. The 94 patients, 51 women and 43 men
(mean age 61 years), underwent one of the following procedures: I,
transthoracic Nissen fundoplication (26 patients); II, Bingham gastroplasty
(20 patients); III, colon interposition (17 patients); IV, jejunal
interposition (10 patients); and V, jejunal bypass (21 patients). Residual
dysphagia (mean follow-up period 62 months) was significantly less in
groups III, IV, and V (p less than 0.05), the more radical procedures, 87%
of the patients having no dysphagic symptoms. This observation was
corroborated by the greatly reduced (one sixth) number of postoperative
dilatations required and also by the reduced need for reoperation. Only the
colon interposition group, however, had an acceptable operative mortality
(0%). The Bingham gastroplasty group also had a 0% operative mortality but
achieved less good functional results, only 55% of patients having no
dysphagic symptoms. Further analysis of functional results showed groups
III, IV, and V to be superior regardless of the preoperative grade of
stricture. The pros and cons of surgical antireflux procedures coupled with
dilatation versus radical procedures to excise the stricture are presented.
We conclude that, for an established benign stricture of the lower
esophagus, colon interposition may offer the best long-term relief from
dysphagia, with very low operative mortality.
