Surgical management of benign strictures of the oesophagus: 18 years of experience

Abstract

Introduction: Benign strictures of the oesophagus are not uncommon. The majority are due to ingestion of corrosives. Different forms of therapy have been recommended. Repeated stricture dilatation has been advocated; when this fails surgical replacement of the oesophagus may be required. There is little information regarding oesophageal dilatation in Sri Lanka. Aim: To retrospectively analyze an 18 year series of patients with benign strictures of the oesophagus treated in a single surgical unit to determine the safety and long term effectiveness of oesophageal replacement by a variety of techniques. Methods: 110 Patients with benign strictures of the oesophagus were treated in a single surgical unit at the Sri Jayawardenapura General Hospital, Nugegoda, Sri Lanka from 1994 to 2011. Clinical, pathological and operative data were reviewed from medical records and interviews with patients and relatives. Results: The male: female ratio was 1.14. Caustic soda ingestion was the commonest cause. Ninety two patients had undergone dilatation prior to presentation without improvement of dysphagia, while 65 had other procedures performed. Transhiatal resection of the oesophagus was the preferred method. Gastric transposition was performed in 67 while the colon was used as the conduit in the others. Recurrence of dysphagia was seen in 8 (7.6%) while the operative mortality rate was 5.4% Conclusion: Surgical treatment of benign strictures of the oesophagus by oesophageal replacement with the stomach or colon is a good option in patients with strictures that do not respond to dilatation and can be carried out with low mortality and morbidity. Repeated attempts at dilatation are unwarranted in such patients. DOI: http://dx.doi.org/10.4038/sljs.v30i1.4502 The Sri Lanka Journal of Surgery 2012; 30(1):18-25