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Oesophageal reconstruction using the stomach
Insights
Esophageal replacement using the stomach showed good outcomes for benign strictures but poor results for esophageal carcinoma. Surgical approaches varied, with transhiatal esophagectomy noting more complications.
Area of Science:
- Thoracic Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Esophageal replacement is a critical procedure for various esophageal pathologies.
- The use of gastric conduits for esophageal substitution has been widely adopted.
- Outcomes can vary significantly based on the underlying indication and surgical technique.
Purpose of the Study:
- To evaluate the outcomes of esophageal replacement using the stomach.
- To analyze the results based on different indications, including carcinoma and benign strictures.
- To compare the morbidity and mortality associated with various surgical approaches.
Main Methods:
- Retrospective analysis of 47 esophageal replacement procedures using the stomach.
- Procedures performed between January 1975 and December 1989 at University College Hospital, Ibadan.
- Data collected on patient demographics, indications, surgical approaches, complications, and outcomes.
Main Results:
- Overall survival was 54.7% with good functional results (absence of dysphagia).
- High mortality (58.8%) observed in patients with esophageal carcinoma.
- Benign strictures (corrosive, peptic) showed better survival rates.
- Transhiatal esophagectomy was associated with higher morbidity compared to other routes.
- Intra-operative mortality was 4.3%.
Conclusions:
- Gastric esophageal replacement is effective for benign conditions, offering good long-term results.
- The procedure yields poor outcomes for esophageal carcinoma in this setting, necessitating alternative strategies.
- Surgical approach selection impacts morbidity; careful consideration is advised.
Abstract:
Between January 1975 and December 1989, the Cardiothoracic Unit of the University College Hospital, Ibadan (U.C.H.) carried out 47 oesophageal replacement procedures using the stomach. The ages of the patients ranged from 3 to 75 years (mean = 53.2 +/- 19.3 years). There were 24 males and 23 females. The indications for oesophageal replacement were as follows: Carcinoma of the oesophagus--34 patients (73.9%), Corrosive stricture--9 patients (17.4%), peptic stricture--1 patient (2.2%), granulomatous oesophageal lesion--1 patient (2.2%), submucous cysts--1 patient (2.2%), oesophageal perforation--1 (2.2%). Twenty patients (58.8%) with oesophageal carcinoma died between 9 and 33 days after operation. The patients with oesophageal perforation, granulomatous lesion and submucous cysts died from sepsis 8, 13 and 6 days respectively after operation due to anastomotic leak. Three patients with corrosive stricture (24%) died 10, 13 and 15 days respectively after operation. All the other 21 (54.7%) patients survived with good results as judged by the absence of dysphagia. Eight of the fourteen surviving patients with carcinoma are lost to follow-up and are presumed dead. There were two intra-operative deaths (4.3%). The operative approaches used were: Transthoracic (21 patients; 9 deaths), Transhiatal oesophagectomy (14 patients; 9 deaths) and retrosternal route (12 patients; 8 deaths). In terms of morbidity, more complications were observed with the transhiatal oesophagectomy (Orringer's technique). It is concluded that whereas oesophagoplasty with the stomach offers good results in patients with benign strictures, the results with carcinoma of the oesophagus in our environment is poor.