Preserving the native esophagus in caustic esophageal stricture using novel strategies including fundoplication, resection and myotomy

Abstract

Esophageal stricture is a well-known complication following caustic ingestion. Esophageal dilatation is the commonest approach to treat this complication. However, patients with a refractory esophageal stricture will require surgical interventions such as esophagectomy with gastric pull up or other forms of esophageal replacement with colonic or small intestinal interposition. We describe two patients with caustic-induced esophageal stricture managed successfully by using novel surgical strategies to preserve the native esophagus. One child underwent resection of the strictures and the subsequent esophageal gap was bridged by lengthening the esophagus using a Livaditis myotomy technique. The other had a fundoplication to manage her reflux which was complicating her clinical course, followed by subsequent myotomy to manage her residual upper esophageal stricture. Patients with short-segment, post-caustic esophageal stricture may be amenable to less drastic surgical procedures using myotomy, thereby preserving the native esophagus, instead of requiring esophageal replacement by another gastrointestinal conduit.