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Gastric vascular pedicle patch esophagoplasty for stricture
G Ramirez Schon1, A Suarez Nieves, J Cebollero Marcucci
1Department of Surgery, Mayaguez Medical Center, Puerto Rico.
The Annals of Thoracic Surgery
|September 1, 1989
Summary
This study presents a surgical approach for Barrett's esophagus strictures using Nissen fundoplication and gastric vascular pedicle patch esophagoplasty. The procedure showed promising results for recalcitrant esophageal strictures, with long-term symptom relief in most patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Esophageal Surgery
Background:
- Barrett's esophagus can lead to esophageal strictures, causing significant dysphagia.
- Refractory strictures often require advanced surgical interventions.
- Previous treatments like antireflux operations or dilation may be insufficient.
Observation:
- Three patients with long-standing Barrett's esophagus and esophageal strictures were treated.
- The surgical technique involved infradiaphragmatic Nissen fundoplication and gastric vascular pedicle patch esophagoplasty using right gastroepiploic vessels.
- Follow-up periods ranged from 6 to 7 years for two patients.
Findings:
- Two patients remained asymptomatic, with one experiencing mild intermittent dysphagia.
- One patient developed esophageal cancer one year post-surgery and required esophagectomy with colon interposition.
- The surgical approach demonstrated efficacy in managing complex lower intrathoracic esophageal strictures.
Implications:
- This surgical method offers a viable option for recalcitrant esophageal strictures unresponsive to standard treatments.
- It highlights the potential for successful management of Barrett's esophagus complications.
- Further research may explore long-term outcomes and oncological surveillance in patients undergoing this procedure.