Pharyngoesophageal post-corrosive stricture treated by one stage retrosternal ‘by-pass’ coloplasty

Abstract

High and extensive post-corrosive pharyngo-esophageal stricture is a difficult therapeutic problem. The only possible way to avoid the misery of life-long gastrostomy and to restore swallowing is total reconstruction of the esophagus. The authors present their experience with 52 such patients treated by retrosternal‘by-pass’coloplasty. During a period ranging from 1964 to 1993 a total of 237 esophagocoloplasties were carried out for undilatable post-corrosive stricture of the esophagus. 52 patients had combined, extensive stricture of the esophagus involving the pharynx, the hypo-pharynx and the entire esophagus. 10 patients had supraglottic, 31 patients had hypopharyngeal stricture and 11 patients had a high cervical stricture. The interval from injury to reconstruction ranged from 6 months to 58 years. Retrosternal‘by-pass’ileo-coloplasty was done in 22 patients and coloplasty in the remaining 30 patients. Transhiatal esophagectomy had been done in 3 patients only, and additional gastric antrum corrective surgery in 11 patients. Three patients died after operation. Early post-operative complications were infrequent. Long-term followup ranged from 1 to 20 post-operative years. 42 patients (85.6%) had good long-term results, 2 had fair and 1 had poor results from surgery. Four patients were lost to follow up. One stage retrosternal‘by-pass’coloplasty yields good results in the management of pharyngo-esophageal postcorrosive stricture in the majority of patients.