The Surgical Treatment of Peptic Ulceration and Stricture of the Lower Esophagus

The Treatment of Fibrous Stricture of the Oesophagus Associated with Hiatal Hernia

“…MacLean and Wangensteen (1956) reported 18 cases of fibrous stricture in which, according to them, only eight had a hiatal hernia, and they only considered it worth while to repair the hernia in three of these eight. Sweet et al (1954) reported 50 cases of which 48 had hernias. Though all were treated surgically in various ways they do not mention repairing the hernia in any of them.…”

“…Most authors favour some sort of resection (Allison, 1951;Allison, Wooler, and Gunning, 1957; Barrett, 1952Barrett, , 1957Belsey, 1953;Ellis, 1956;Ellis, Andersen, and Clagett, 1956;Lindskog and Kline, 1957;MacLean and Wangensteen, 1956;Mustard, 1957;Sweet, Robbins, Gephart, and Wilkins, 1954;Tanner, 1955;Wooler, 1956), but few agree on what is to be removed or how best to reconstitute the alimentary canal afterwards. Many variations of resection of oesophagus, or stomach, or both, with all sorts of anastomoses which may or may not involve the jejunum or colon, have been advocated.…”

Surgery of the Esophago‐gastric Region: Use of the Gastric‐remnant Interposition Procedure

“…Such an anastomosis has not been followed by esophagitis in Valdoni's experience. However, Sweet et al (4) found that less than 25 per cent of the patients became asymptomatic after this operation, though when extensive gastric resection was performed a considerable number obtained relief. ) Resection of the involved esophago‐gastric region, with closure of the open end of the distal gastric remnant left in situ, and anastomosis of the esophagus to a Roux loop of jejunum—Allison (6). Allison stated that any form of esophagogastrostomy is to be avoided in surgical correction of the complications of reflux esophagitis.…”

“… ) Subtotal gastric resection—Wangensteen and Leven (3). The object is to reduce the acid secretion of the stomach so that the wound will heal properly. ) Esophago‐gastrectomy—Sweet and associates (4). Whether the operation is conservative or extensive, the esophagus is anastomosed to the gastric remnant.…”

“…) Esophago‐gastrectomy—Sweet and associates (4). Whether the operation is conservative or extensive, the esophagus is anastomosed to the gastric remnant.…”