Prevention and management of strictures after hypopharyngocolostomy or esophagocolostomy

Abstract

The records of 14 patients who underwent surgical revision for anastomotic strictures after hypopharyngocolostomy or esophagocolostomy were reviewed. The esophageal reconstruction was originally performed for esophageal strictures or resections after corrosive injury in 13 patients and for achalasia in 1. The esophageal substitutes used consisted of right ileocolon in 12 patients and left colon in 2. Routes of colon positioning were substernal in 13 patients and subcutaneous in 1. One-half of all strictures were located at the hypopharynx and the other half at the cervical esophagus. Causes of the strictures were anastomotic leakage in 5 patients, progressive caustic scarring in 4, graft ischemia in 3, combined caustic and tuberculous scar in 1, and technical error in 1. The interval from esophageal reconstruction to the revision was 1 month to 15 years with a median of 7 months. Surgical approaches included cervical incision only in 9 patients, cervical incision plus sternotomy in 3, and cervical incision plus partial resection of sternal manubrium in 2. Revisional procedures consisted of excision of scar with reanastomosis in 12 patients, skin graft in 1, and free jejunal graft in 1. After revision, all but 1 patient had excellent results. On the basis of these experiences we conclude that most strictures after pharyngocolostomy or esophagocolostomy can be surgically corrected after excision of the scar and mobilization of the esophageal substitute through a cervical incision only or a cervical incision plus sternotomy.