Esophageal reconstruction with intraoperative dilatation of the hypopharynx for the management of chronic corrosive esophageal strictures.

Abstract

Chronic corrosive strictures of the upper cervical esophagus and hypopharynx resulting from ingestion of caustic substances are a challenging surgical entity when repeated endoscopic dilatations fail to yield satisfactory results. Restoring the continuity of the upper digestive tract by esophageal substitution at healthy tissue margins not only compromises the integrity of the swallowing mechanism, but also often requires the performance of a tracheostomy in order to ensure avoidance of recurrent aspirations. We describe three cases of corrosive upper cervical esophageal strictures treated with intraoperative dilatation of the proximal hypopharyngeal stump and concurrent 'stenting' of the pharyngeal anastomosis with the conduit replacing the esophagus. All patients tolerated the procedure well. Avoidance of both impairment of deglutition and respiratory complications, as well as restoration of normal esophageal function, was successfully accomplished.

Serratia marcescens causing cervical necrotizing oropharyngitis

“…Much of the published literature regarding management of hypopharyngeal stenosis recounts experience in adult patients after operative and/ or radiation therapy for treatment of upper aerodigestive malignancies [11,12] or in pediatric and/ or adult patients after caustic ingestion [13,14]. As in the setting of caustic ingestion, the degree of significant tissue loss in our patient's oropharynx made circumferential scarring difficult to avoid without early placement of a free tissue graft.…”

Upper Digestive Tract Reconstruction for Caustic Injuries

“…Unauthorized reproduction of this article is prohibited. [3][4][5][6][7][8][9][10][11][12][13][14] 18 [11][12][13][14][15][16][17][18][19][20] 0.06 * Percentage are calculated among the 107 patients in whom functional outcomes could be assessed. Data are N (%) or median [IQR] unless otherwise indicated.…”

“…At the end of the followup period, 1 patient (1%) in the esophagocoloplasty group and 17 patients (16%) in the colopharyngoplasty group had a tracheotomy tube (P < 0.0001). The median delay in jejunostomy removal was 3 [2][3][4][5] months after esophagocoloplasty and 9 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] months after colopharyngoplasty (P < 0.0001).…”

“…Surgical management of pharyngeal strictures is a difficult challenge as mirrored by the large diversity of surgical procedures described for its treatment. [2][3][4][5][6][7][8][9][10] Throughout time, most of these techniques fell into disuse because of high morbidity and low success rates.…”

A Case of Corrosive Injury-Induced Pharyngeal Stricture Treated by Endoscopic Adhesiolysis Using an Electrosurgical Knife

“…Surgical correction is generally undertaken if multiple, repeated dilations are unsuccessful, but localized, segmental narrowing can be corrected by various methods depending on the length and severity of the stricture 3. For pharyngeal strictures, surgically managed cases including flap4 and colon interposition or pull-up of stomach with or without stenting5,6 were reported, and there were experiences of local treatments such as laser ablations7 and balloon dilation and/or bougienation 8. However, there has been no report of endoscopic incision therapy using electrosurgical knife.…”