Challenges in reversing esophageal discontinuity operations.

Abstract

BACKGROUND:

After catastrophic esophageal or gastric disruption results in esophageal discontinuity, operations to restore swallowing are surgical challenges.

METHODS:

A retrospective review and assessment of functional results was performed in 40 patients (average age 59.9 years) who had 42 operations to reverse esophageal discontinuity between 1973 and 2002.

RESULTS:

Esophageal discontinuity resulted from gastric necrosis after esophagectomy and esophagogastrostomy (n = 10) or hiatal hernia repair (n = 4), esophageal perforation complicating dilatation (n = 5), failed colonic or jejunal interpositions (n = 5), caustic ingestion (n = 4), Boerhaave syndrome (n = 4), esophagogastric anastomotic leak (n = 3), and other causes (n = 6). Eighteen patients (43.9%) required prolonged mechanical ventilation. Thirty-one (75.6%) had an end cervical esophagostomy; 6, an anterior thoracic esophagostomy; 2, lateral esophagostomy and in situ native esophagus stapled and divided distally; and 1 each, a stapled, divided esophagus without esophagostomy and a stapled undivided esophagus without esophagostomy. Twenty-six patients (63.4%) had undergone partial or total gastrectomy. Ten (24.4%) had vocal cord paralysis. Operations reestablishing continuity included colonic interposition in 23 (56.1%), substernal gastric interposition in 7 (17.1%), esophagectomy and cervical anastomosis in 6, esophageal reanastomosis in 3, staged jejunal interposition in 1, and Roux-en-Y esophagojejunostomy in 1. There were no hospital deaths. Twenty-eight patients (68.3%) had postoperative complications. Length of stay averaged 20.6 days. Follow-up for 40 patients averaged 54.5 months. Functional results (39 patients) were excellent in 12 (30.8%), good in 15 (38.5%), fair in 10 (25.6%), and poor in 2 (5.1%).

CONCLUSIONS:

Successful reversal of esophageal discontinuity requires individualized assessment and ingenuity. Despite appreciable morbidity, the ultimate result is generally gratifying.

• Authors: Christina Barkley, Mark B Orringer, Mark D Iannettoni, John Yee
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 76 Issue 4 Pg. 989-94; discussion 995 (Oct 2003) ISSN: 0003-4975 [Print] Netherlands
• PMID: 14529973 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Esophagectomy
• Esophagoplasty (methods)
• Esophagostomy
• Female
• Gastrostomy
• Hernia, Hiatal (surgery)
• Humans
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications (surgery)
• Reoperation
• Retrospective Studies
• Treatment Outcome