JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Jeffrey A. Hagen
Tom R. DeMeester
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gadenstätter, M.
Right arrow Articles by Crookes, P. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gadenstätter, M.
Right arrow Articles by Crookes, P. F.

J Thorac Cardiovasc Surg 1998;115:296-302
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

Esophagectomy For Unsuccessful Antireflux Operations

Michael Gadenstätter, MDa, Jeffrey A. Hagen, MDb, Tom R. DeMeester, MD, FACS, Manfred P. Ritter, MDc, Jeffrey H. Peters, MD, FACS, Rodney J. Mason, MD, PhDb, Peter F. Crookes, MDb

From the Second Department of Surgery, University of Innsbruck, Innsbruck, Austria,a the Department of Surgery, University of Southern California, Los Angeles, Calif.,b and the Department of Surgery, University of Würzburg, Würzburg, Germany.c

Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.

Received for publication May 6, 1997; revisions requested June 17, 1997; revisions received Oct. 6, 1997; accepted for publication Oct 7, 1997. Address for reprints: Jeffrey A. Hagen, MD, Assistant Professor of Surgery, Division of Cardiothoracic Surgery, University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA 90033-4612.

Background: Primary antireflux surgery provides excellent symptom relief in most patients. Unfortunately, the results of redo surgery are less predictable. In these patients, esophageal injury from long-standing reflux of gastric contents and operative trauma from previous failed antireflux procedures results in progressive deterioration in esophageal propulsion, poor clearance of reflux episodes, mucosal damage, and, in some cases, stricture formation. For the past 16 years, we have selectively used esophageal resection and replacement instead of another reoperation in these challenging patients.

Methods: Seventeen patients with end-stage esophageal body dysfunction and one or more previously unsuccessful antireflux procedures underwent esophagectomy and reconstruction by colon interposition in 15 patients and jejunum interposition in 2 patients. The indications for esophagectomy rather than a redo antireflux procedure were a global loss of effective esophageal motility in 13 and a nondilatable stricture in four. Their outcome was compared with that of 32 patients with adequate motility and 18 with a similar global loss of motility who had a redo antireflux procedure. Perioperative complications after esophagectomy were recorded, and long-term outcome was assessed by means of a standardized questionnaire at a median of 7 years after the operation.

Results: Patients with profound esophageal body dysfunction who underwent esophageal resection had outcomes similar to those with normal motility who underwent a redo antireflux procedure. Those with profound esophageal motility dysfunction who underwent a redo antireflux procedure had a worse outcome than those who underwent resection. Esophageal resection and replacement was performed without mortality or graft failure. All patients who underwent resection stated that their preoperative symptoms were relieved completely (n = 6) or improved (n = 10). Thirteen patients (81%) were able to eat three meals a day, and 12 patients (75%) enjoyed an unrestricted diet. Two thirds of the patients were at or above their ideal body weight, and 88% were fully satisfied with the outcome of the procedure.

Conclusion: Patients with end-stage esophageal body dysfunction who have had a previous unsuccessful antireflux procedure can be treated by esophageal resection with a high expectation of success.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
J.-P. Avaro, X.-B. D'Journo, D. Trousse, M. A. Ouattara, C. Doddoli, R. Giudicelli, P. A. Fuentes, and P. A. Thomas
Long-term results of redo gastro-esophageal reflux disease surgery
Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1091 - 1095.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
O. A. Khan, G. Kanellopoulos, M. L. Field, K. R. Knowles, F. D. Beggs, W. E. Morgan, and J. P. Duffy
Redo antireflux surgery--the importance of a tailored approach
Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 875 - 880.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. J. Watson, T. R. DeMeester, W. K. Kauer, J. H. Peters, and J. A. Hagen
Esophageal replacement for end-stage benign esophageal disease
J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1241 - 1245.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1998 by The American Association for Thoracic Surgery.