Operative treatment of corrosive esophageal strictures

Abstract

Introduction: Nowadays operative treatment of corrosive esophageal strictures remains one of the difficult and unsolved problems in surgery. The level of postoperative complications such as anastomotic leak (develops in 7-30% of cases), infections, pneumonia, pleural empyema, mediastinitis, peritonitis, postoperative corrosive strictures is still rather high. The aim of our work was to improve the results of surgical treatment of patients with corrosive esophageal strictures by analyzing and refining on conservative therapy options as well as differentiated approach to each operative treatment method. Materials and methods: 44 patients with corrosive esophageal strictures operatively treated during the period of 1993-2017 were examined. Indications for each of esophagoplasty techniques were established. In colon bypass of the esophagus (26 patients) infusion therapy for prevention of ischemic transplant disorders, roentgenologic and prevascular preparation of future colonic transplant, anti-reflux colonogastric anastomosis were suggested. In gastric esophagoplasty (10 patients), clinically modified transhiatal extirpation of the esophagus with gastric tube plastics, an original method of lengthening of gastric graft, is preferred in clinical practice. Two patients underwent ileocecal segment esophagoplasty because of simultaneous esophageal and gastric lesion or colon diseases. Results: The best method of esophagoplasty associated with a small number of postoperative complications is clinically modified gastric tube esophagoplasty with formation of single extrapleural esophagogastric anastomosis. In cases when the stomach cannot be used and the marginal artery is well marked, isoperistaltic retrosternal colonoplasty with preservation of blood supply due to the left colonic artery is indicated. Suggested method of ileocecal segment esophagoplasty is used in simultaneous esophageal and gastric lesion, providing the formation of relevant reservoir (the cecum instead of the stomach), antireflux mechanism and preventing the development of peptic ulcers and transplant strictures. Conclusions: Operative treatment of corrosive esophageal strictures remains a great challenge for surgeons and should be based on individual choice of proper method of esophagoplasty and final intraoperative decision making.