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Surgical treatment of reflux stricture of the esophagus
Insights
Surgical management, including Nissen fundoplication, effectively treats peptic esophageal stricture in children. Most patients achieve symptom relief without dilation, but resistant cases may require further intervention.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Diseases
Background:
- Peptic esophageal stricture is a significant cause of morbidity in children.
- Management often involves addressing gastroesophageal reflux and potential complications like anastomotic strictures.
Purpose of the Study:
- To evaluate the efficacy of surgical management for peptic esophageal stricture in pediatric patients.
- To assess outcomes of Nissen fundoplication and subsequent interventions.
Main Methods:
- Retrospective review of 10 children (7 months to 15 years) with peptic esophageal stricture.
- Diagnosis confirmed via esophagography, pH monitoring, manometry, and esophagoscopy.
- Surgical intervention included transabdominal Nissen fundoplication, with some cases requiring dilatation or prior stricture excision.
Main Results:
- Seven of nine children who underwent Nissen fundoplication became symptom-free within 2-3 months without dilation.
- Two children with anastomotic stricture improved after 1-2 postoperative dilatations.
- One patient with a long-standing stricture showed no improvement despite repeat antireflux surgery and dilatations.
Conclusions:
- A conservative surgical approach, primarily Nissen fundoplication, is effective for pediatric peptic esophageal stricture.
- Direct surgical intervention for stricture is reserved for cases resistant to antireflux surgery and with a history of prolonged reflux.
Abstract:
Ten children, aged 7 months to 15 years, with peptic esophageal stricture, were treated surgically. In four of the children, the stricture had occurred after esophageal anastomosis. Peptic stricture was diagnosed by esophagography, pH monitoring, manometry, and esophagoscopy. Barrett's esophagus was found in two children. Nine children underwent transabdominal Nissen fundoplication initially. In the first child of this series, a tight anastomotic stricture had been excised 2 weeks before fundoplication. Seven children became complaint-free within 2 or 3 months after fundoplication without any dilatation, and two children with anastomotic stricture improved after 1 or 2 postoperative dilatations. The condition of one boy, with a 6-year history of tight stricture, did not improve with repeat Nissen and subsequent dilatations. Histological examination showed proliferation of smooth muscle cells in the submucosa. A conservative surgical approach is effective for the management of peptic esophageal stricture in children, and direct surgical intervention for stricture should be attempted only in cases of stricture resistant to antireflux surgery with a long history of reflux.