Relevance of anatomopathology of high oesophageal strictures to the design of surgical treatment

Abstract

From 1971-1987, inclusive, 407 patients with oesophageal stricture were operated on by one surgeon. Of these, 116 were found to have high oesophageal stricture and form the basis of this presentation. Every patient had the usual clinical, radiological and endoscopic examinations with biopsies taken above, at, and (when possible) below the stricture. At operation, the surgical anatomy and pathology of the oesophagus and mediastinum were determined and the site of the peritoneal reflexion and its relation to the stricture were noted. In those resected, the resected specimen was examined histopathologically. Thus clear aetiopathology could be established and this was correlated with the type of operation. Postoperatively, patients were followed up regularly. Results showed that high strictures were of four definite types: (1) reflux strictures with short oesophagus (n = 90) of whom 52% required resection and 48% had conservative surgery, (2) caustic and other non-reflux strictures (n = 10) all of whom required resection, (3) Barrett-type strictures (n = 8) all treated by conservative surgery, (4) idiopathic strictures (n = 8) of whom half required resection because of suspicion of malignancy. The study indicated that the rational basis for the design of surgery is to ascertain the aetiopathology which can only and finally be determined at operation.