Related Experiment Videos
Challenges in reversing esophageal discontinuity operations
Christina Barkley1, Mark B Orringer, Mark D Iannettoni
1University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
The Annals of Thoracic Surgery
|October 8, 2003
Summary
Reversing esophageal discontinuity after severe disruption is surgically challenging but achievable. Despite significant complications, reconstructive surgery generally yields gratifying functional outcomes for patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Thoracic Surgery
Background:
- Catastrophic esophageal or gastric disruption presents significant surgical challenges in restoring swallowing function.
- Esophageal discontinuity necessitates complex reconstructive procedures.
Purpose of the Study:
- To evaluate the functional outcomes of surgical interventions for esophageal discontinuity.
- To assess the morbidity and success rates of various reconstructive techniques.
Main Methods:
- Retrospective review of 40 patients who underwent 42 operations to reverse esophageal discontinuity between 1973 and 2002.
- Analysis of patient demographics, causes of esophageal discontinuity, surgical procedures, complications, and functional results.
Main Results:
- Esophageal discontinuity arose from diverse causes including gastric necrosis, hiatal hernia repair complications, esophageal perforation, failed interpositions, caustic ingestion, Boerhaave syndrome, and anastomotic leaks.
- Common reconstructive procedures included colonic interposition (56.1%) and substernal gastric interposition (17.1%).
- Despite a high rate of postoperative complications (68.3%) and prolonged recovery, functional results were excellent or good in over 68% of patients, with no hospital deaths.
Conclusions:
- Successful reversal of esophageal discontinuity demands individualized patient assessment and surgical creativity.
- While associated with considerable morbidity, reconstructive surgery for esophageal discontinuity generally leads to gratifying functional outcomes.