Surgery for benign esophageal stricture

The long-term results of five different operations for benign lower esophageal reflux stricture, carried out over the 5 year period 1973 to 1977, are presented and evaluated. The 94 patients, 51 women and 43 men (mean age 61 years), underwent one of the following procedures: I, transthoracic Nissen fundoplication (26 patients); II, Bingham gastroplasty (20 patients); III, colon interposition (17 patients); IV, jejunal interposition (10 patients); and V, jejunal bypass (21 patients). Residual dysphagia (mean follow-up period 62 months) was significantly less in groups III, IV, and V (p less than 0.05), the more radical procedures, 87% of the patients having no dysphagic symptoms. This observation was corroborated by the greatly reduced (one sixth) number of postoperative dilatations required and also by the reduced need for reoperation. Only the colon interposition group, however, had an acceptable operative mortality (0%). The Bingham gastroplasty group also had a 0% operative mortality but achieved less good functional results, only 55% of patients having no dysphagic symptoms. Further analysis of functional results showed groups III, IV, and V to be superior regardless of the preoperative grade of stricture. The pros and cons of surgical antireflux procedures coupled with dilatation versus radical procedures to excise the stricture are presented. We conclude that, for an established benign stricture of the lower esophagus, colon interposition may offer the best long-term relief from dysphagia, with very low operative mortality.