Short-segment jejunoplasty: the option treatment in the management of benign esophageal stricture

Abstract

A non-dilatable benign stricture of the esophagus is a problem for the patient and always a challenge for the surgeon. The present study is intended to provide some details of surgical technique and the physiological concept that constitutes the basis for patient selection for short-segment jejunoplasty. In this study, out of 98 patients, 91 had complex stricture of the lower, and seven of the cervical esophagus. The main cause of stenosis in 60 patients (61.2%) was gastroesophageal reflux, in 34 (34.7%) post-corrosive damage, and in three (3.0%) it was other causes. All patients were treated by three methods of jejunoplasty: group I (n=54 patients) short-segment of the jejunum; group II (n=37 pts) Roux-en-Y double tract; and group III (n=7 patients) short jejunal segment on the long vascular pedicle. Intraoperative complications occurred in 17 (17.34%) of the patients. An anastomotic leak occurred only in three (3.29%) in group I and II, and 1/98 patients (1.02%) died from mediastinitis. Follow-up of functional results for up to 36 months (average 18 months) was available in 77/97 (79.3%) hospital survivors. Fifty-seven (74%) patients are satisfied with their ability to take food, postoperative reflux was completely denied by 72 (93.5%) patients. Postvagotomy diarrhea was transient and gradually subsided over the course of the first 6 months.

Esophageal stricture caused by reflux esophagitis requiring subtotal esophagectomy: a case report

“…The long-term effectiveness of surgery for benign esophageal stricture is high, but surgery is highly invasive, and one study has reported that the postoperative mortality rate for benign diseases is 5% and the rate of complications is 56% [16]. There are many different surgical approaches for patients with refractory esophageal strictures that are not responsive to interventions [16,17]. When classifying surgical approaches in three types, dilatation, if possible, and fundus plication constitute the least invasive type.…”

Therapeutic Options for Management of Pharyngoesophageal Corrosive Strictures

“…1,14,15 Other procedures such as free jejunal grafts were not tried by us. 16 These require considerable technical expertise, are useful only for short segments, and are associated with a high rate of early post-operative morbidity. 17, 18 We have also not used the platysma myocutaneous flap described by Zhou et al 15 or the gastric tube interposition of Matsuki et al 19 In conclusion, pharyngoesophageal strictures require considerable expertise in management, and one should be aware of various options for this purpose.…”