Surgical management of benign stricture from reflux oesophagitis.
From January 1976 to December 1994, out of 605 patients with reflux oesophagitis, 166 (27.4%) presented with an oesophageal stricture, and 68 of these (40.9%) underwent surgical therapy. Thirteen of the 68 patients (19.1%) had an associated Barrett's oesophagus. Oesophageal manometry revealed scleroderma in nine individuals (13.2%). The stricture was undilatable in 11 patients (16.1%) observed before 1985. An oesophageal-sparing operation was performed in the majority of patients: fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), and total duodenal diversion (n = 4). Oesophageal resection was performed in 15 patients (22%); 12 of these individuals were operated on before 1985. The mortality rate was 4.4%: two patients died of necrosis of the interposed colon and one of acute pancreatitis. The average follow-up time was 27 months (8-136). Oesophageal-sparing procedures significantly reduced the need for further endoscopic dilatation (P < 0.001). Standard fundoplication was successful in 30 out of 39 patients (77%). Reasons for a failed fundoplication were a long, hard stricture, an ineffective partial wrap in patients with unrecognized short oesophagus, or underlying scleroderma. Regression of Barrett's mucosa was not recorded with any of the conservative surgical procedures.
Bonavina
L
L
Department of General and Oncologic Surgery, University of Milan, Italy.
Segalin
A
A
Fumagalli
U
U
Peracchia
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology / Q000401:mortality / Q000601:surgery; D003106:Colon / Q000637:transplantation; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D004942:Esophagitis, Peptic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome