The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 649-653, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Treatment of severe peptic esophageal stricture with Roux-en-Y partial gastrectomy, vagotomy, and endoscopic dilation. A follow-up study
JA Salo, KV Ala-Kulju, LO Heikkinen and EO Kivilaakso
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Eleven patients with dysphagia caused by severe esophageal stricture
(length 2 to 10 cm) resulting from reflux esophagitis were treated with
fibroendoscopic dilation (Eder-Puestow) and Roux-en-Y partial gastrectomy
with vagotomy during 10 years (1979 to 1988). There was no operative
mortality, but complications developed in three patients: One patient had a
mediastinal abscess demanding thoracotomy as a result of esophageal
perforation after dilatation; one had postoperative pneumonia; and one
patient had ileus. After a mean follow-up of 4 years (range 1 to 10 years)
esophagitis healed in all cases, as judged by endoscopy. Eight patients
were asymptomatic, but three had slight transient dysphagia.
Postoperatively one to eight dilations (average three to four) were needed
to relieve dysphagia in the first postoperative year, but later the
stricture healed in every case. Postoperative pH measurement was performed
in six latest patients and showed complete absence of reflux in all cases.
It is concluded that Roux-en-Y partial gastrectomy with vagotomy and
endoscopic dilation is an effective, simple, and safe procedure in the
management of severe peptic esophageal (acid or alkaline esophagitis)
stricture. However, occasional postoperative dilations at the outpatient
clinic are often needed in severe cases in the first postoperative year.
