Carcinoma of the esophagus engrafted on corrosive stricture of the esophagus

A highly significant incidence of esophageal cancer engrafted on corrosive stricture of the esophagus has been statistically evaluated. So far, only 8 cases in Japan and over 100 cases in foreign literatures have been reported. In 1976, we reported the first case of carcinoma of the esophagus associated with corrosive stricture of the esophagus in Japan. Our second case operated in 1975 was pathologically confirmed to be adenosquamous carcinoma of the esophagus which has never been reported in the literatures. In this paper surgical and pathological problems of the carcinoma of the esophagus associated with corrosive stricture of the esophagus were discussed adding to the analysis of 8 reported cases in Japan.     

Gastric antral patch esophagoplasty for extensive corrosive stricture of the esophagus

A case is reported of a patient with a 9-cm stricture of the esophagus caused by ingestion of sodium hydroxide, who was treated by gastric antral patch esophagoplasty. In this procedure, a full-thickness pedicled patch of gastric antrum, based on the left gastroepiploic artery, was used to enlarge the esophageal lumen, thus allowing preservation of esophageal continuity and utilization of a functioning lower esophageal sphincter. The patient ate normally after the operation, and radiological, manometric, and esophageal pH monitoring studies indicated satisfactory esophageal function. Gastric antral patch esophagoplasty avoids the complications associated with esophageal bypass or resection. Previous long-term results of this procedure in patients with reflux-induced esophageal stricture have been good, and the technique merits consideration in the treatment of severe corrosive strictures.

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Resumen Se informa el caso de un paciente con una estrechez esofágica de 9 cm causada por ingestión de hidróxido de sodio, tratado mediante esofagoplastia y con parche antral. En este procedimiento se utilizó un parche de espesor total de antro gástrico, con base en la arteria gastro-epipoica izquierda, con el objeto de aumentar la luz del esófago, para así preservar la continuidad esofágica y permitir la utilización del esfínter esofágico inferior. El paciente pudo corner normalmente después de la operatión, y los estudios de monitoria radiológica, manométrica y de pH esofágico indicaron satisfactoria función del esófago.La esofagoplastia con parche gástrica antral evita las complicaciones asociadas con la derivatión (bypass) o la resectión esofágica. Estudios anteriores de los resultados a largo plazo con este procedimiento en pacientes con estrechez esofágico producida por reflujo han demostrado buenos resultados, y la técnica merece ser considerada en el tratamiento de estenosis corrosivas severa.

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Résumé Une oesophagoplastie par patch antral a été effectuée chez un patient ayant une sténose caustique due à l'ingestion d'hydroxide de sodium. L'intervention a consisté en la confection d'un lambeau gastrique antral avec comme pédicule nourricier l'artère gastro-épiploïque gauche. Ce pédicule a ensuite été utilisé pour élargir la lumière oesophagienne, permettant de préserver la continuité oesophagienne et de conserver le sphincter inférieur de l'oesophage. Après cette opération, le patient était capable de manger normalement: les études radiologique, manométrique, et la pH métrie indiquaient que la fonction oesophagienne était satisfaisante.L'oesophagoplastie par patch antral évite les complications associées aux oesophagoplasties classiques ou à la résection. En raison des bons résultats à long terme de cette technique dans le traitement des sténoses peptiques par oesophagite, l'oesophagoplastie par patch antral mérite d'être envisagée dans la correction des sténoses caustiques sévères.

     

Pharyngoesophageal bypass using a free jejunal graft for corrosive stricture

The management of corrosive strictures of the esophagus involving the pharynx and/or larynx continues to be a challenge to surgeons. This paper presents a case of a corrosive stricture extending from the hypopharynx to the cervical esophagus associated with complete obstruction of the larynx, which was successfully treated by pharyngoesophageal bypass using a free jejunal graft. Postoperative recovery was smooth without any complications, and swallowing was restored. Three months after the bypass operation, the patient underwent laryngoplasty. Although aspiration occurred immediately after the laryngoplasty, six months later the was again able to tolerate the oral intake of semisolid food without any need for supplementary nutritional support. Reconstruction of a short segment of the pharyngoesophageal stricture by a free jejunal graft restores almost normal swallowing provided that dilatation of the lower esophagus is achieved.     

Palliative retrosternal reconstruction in cancer of the esophagus

Among patients presenting with a cancer of the esophagus, only a third will have a theoretical radical resection. Out of our management: 1 - By pass with operatory abdominal and cervical check up--2 - Chemotherapy--3 - Total esophageal resection by thoracotomy, 29 patients get through the first stage only, which is then considered as a palliation method. Results obtained about the degree of palliation, i.e. quality of life, pathologic incidences, mortality rates are compared with other methods.     

Laparoscopic retrosternal gastric pull-up for fistulized mediastinal mass

We describe the case of a patient successfully reconstructed with laparoscopic retrosternal gastric pull-up after esophagectomy for unresectable posterior mediastinal inflammatory myofibroblastic tumor, eroding into the esophagus and compressing the airways. A partial esophagectomy with esophagostomy was performed for treatment of esophageal pleural fistula and empyema, while the airways were managed with the placement of an endobronchial stent. Gastrointestinal reconstruction was performed using a laparoscopic approach to create a retrosternal tunnel for gastric conduit pull-up and cervical anastomosis. The patient was discharged uneventfully after 6 d, and has done very well at home with normal diet.     

Oesophageal resection with cervical oesophagogastrostomy for corrosive oesophageal stricture

An 8-year experience of the surgical treatment of 28 patients with corrosive oesophageal stricture is reviewed. Eight patients underwent oesophageal bypass using colonic or jejunal graft with one death (12.5 per cent mortality). The single death (5 per cent mortality) among 20 patients undergoing oesophageal resection was not related to the technical difficulty of the operation. In 17 of these patients reconstruction was by cervical oesophagogastrostomy and in 2 by pharyngogastrostomy. One case of oesophageal carcinoma occurred among 5 cases of corrosive stricture exceeding 20 years in duration. Oesophageal resection for severe corrosive stricture is not a hazardous procedure as generally believed and is desirable in view of the pre-malignant nature of corrosive stricture. Reconstruction by cervical oesophagogastrostomy after oesophageal resection is advantageous because of its relative simplicity and safety.     

Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture

Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.     

Management of corrosive injuries of the esophagus.

During a 5-year period from 1993 to 1998, 22 cases of caustic esophageal injuries were referred to our clinic, caused by acid consumption as suicidal intentions or as an accident. Four out of 10 cases where acute exploration was performed the corrosion was so extended that no further intervention could be done, and all of them died within 24 hours. In the remaining 6 cases acute esophagogastrectomy, or total gastrectomy with esophageal exclusion was performed. Three out of 6 patients survived primary surgery, who later underwent esophageal reconstruction with a colon substitute. In 12 patients no indication for acute surgery arose, but later during the follow-up in 5 of them dysphagia and corrosive stricture developed. All underwent successful esophageal reconstruction with colon substitute. Case reports, acute management, indications for surgery and prognostic factors are also discussed.     

Pharyngo-enteral anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture

BACKGROUND: Diseases involving the entire esophagus usually require extensive surgical procedures to accomplish functional reconstruction. These procedures are extremely stressful for undernourished patients. We have utilized a simpler procedure for total esophageal reconstruction. METHODS: This retrospective report reviews the experience in 8 patients who underwent esophageal reconstruction by pharyngo-colo-gastrostomy or jejunostomy without any resection of bony structures. RESULTS: There was no operative or hospital death. Complications included anastomotic stenosis, transient leak from the ileal stump, and late enterocutaneous fistula, each in 1 patient. Laryngeal function was maintained without special treatments. After swallowing training for approximately 1 week, oral feeding was resumed. All patients have gained 7 to 21 kg at 35 to 67 months after surgery. CONCLUSIONS: Our surgical procedure is shown to be safe and effective in undernourished patients with diffuse esophageal stricture.     

咽结肠吻合治疗食管烧伤后瘢痕狭窄

目的 总结采用咽结肠吻合治疗食管烧伤后瘢痕狭窄的经验及效果。方法 回顾分析14例应用咽结肠吻合重建食管治疗累及下咽的广泛食管烧伤后瘢痕狭窄患者的临床资料。均采用左半结肠,旷置胸内瘢痕食管、经胸骨后隧道上提至颈部行咽结肠吻合。结果 全组无手术死亡,术后发生颈部吻合口漏4例,腹部切口裂开1例。随访半年至10年,平均4年,2例分别于术后3个月及4个月发生吻合口狭窄,1例扩张,1例行成形术治愈;1例因移植结肠腹腔段呈袋状而致进食后呕吐,行结肠胃侧侧吻合治愈。结论 咽结肠吻合治疗累及下咽的广泛性食管烧伤后狭窄成功关键是较大的下咽开口及良好的吻合技术,咽结肠吻合是安全、有效的。