This paper is only available as a PDF. To read, Please Download here.
Abstract
Two areas of esophageal surgery pose difficult and unsettled problems of management:
reoperation for complications of fundoplication and the columnar-lined distal esophagus
(Barrett's). Fifteen patients have required reoperation for gastric fistula (six),
progressive esophagitis/stricture (four), obstruction by the wrap (three), carcinoma
(one), failed pericardioesophagoplasty (one), and gastric ulcer (one). Of the six
with gastric fistulas, five had had transthoracic Nissen procedures, and three died
without surgical closure having been attempted. Three survived after operative closure
(one) and esophageal exclusion (two). Progressive esophagitis/stricture occurred following
abdominal Nissen operations (two), Belsey procedure (one), and Belsey with Collis
gastroplasty (one). Remedial thoracic Nissen operations gave good results in two patients.
Esophageal obstruction by the wrap (three) was managed by resection and distal colon
interposition with good results in each patient. Those with cancer, a failed pericardioesophagoplasty,
and gastric ulcer were managed by esophagogastrectomy, Woodward procedure, and wedge
resection, respectively. All are doing well. Eight patients had Barrett's esophagus,
one with an associated cancer (13%). Fundoplication has given good results in three
of five patients, and there was one death from gastric fistula. Two are awaiting operation.
Failed operations on the gastroesophageal junction can be remedied by carefully selected
surgical techniques based on a thorough preoperative evaluation of the patient. Barrett's
esophagus is managed successfully with fundoplication and dilatation. There is an
increased incidence of cancer in this disorder, which demands long-term follow-up.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The treatment of sliding hiatus hernia and reflux esophagitis by the Mark IV technique.Surgery. 1967; 62: 396
- Reconstruction of the esophagus with left colon.J Thorac Cardiovasc Surg. 1965; 49: 33
- Columnar cell-lined esophagus: Assessment of etiology and treatment. A 22 year experience.J Thorac Cardiovasc Surg. 1976; 71: 825
- Pericardioesophagoplasty. A new method for partial esophageal replacement.Am J Surg. 1973; 125: 294
- Evaluation of current operations for the prevention of gastroesophageal reflux.Ann Surg. 1974; 180: 511
- Conservative surgical treatment of reflux esophagitis and esophageal stricture.Ann Surg. 1975; 181: 552
- An effective operation for hiatal hernia. An eight year appraisal.Ann Surg. 1967; 166: 681
- Simplified management of reflux esophagitis with stricture.Ann Surg. 1970; 172: 638
- Treatment of peptic esophageal stricture with combined fundic-patch-fundoplication.Ann Surg. 1975; 182: 472
- Attitude chirurgicale dans le traitement du brachy-oesophage acquis.Ann Chir. 1976; 30: 185
- Columnar-lined lower esophagus: An acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus With 12 adenocarcinomas.J Thorac Cardiovasc Surg. 1975; 70: 826
- Eine einfache Operation zur Beeinflussung der Reflux-Oesophagitis.Schweiz Med Wochenschr. 1956; 86: 590
- Long term results of the Mark IV operation for hiatal hernia and analysis of recurrence and their treatment.J Thorac Cardiovasc Surg. 1972; 63: 25
- Gastroesophageal reflux in esophageal scleroderma: Diagnosis and implications.Ann Thorac Surg. 1976; 22: 120
Orringer, M. B., Sloan, H.: Complications and failings of the combined Collis-Belsey operation. J Thorac Cardiovasc Surg In press
- Gastroplasty and Belsey hiatus hernia repair. An operation for the management of peptic stricture with acquired short esophagus.J. Thorac Cardiovasc Surg. 1971; 61: 50
- Long-term follow-up of peptic strictures managed by dilatation, modified Collis gastroplasty, and Belsey hiatus hernia repair.Surgery. 1976; 80: 396
- Hiatal hernia and esophagitis: A survey of indications for operation and technic and results of fundoplication.Ann Surg. 1971; 173: 775
- Fundoplication for reflux esophagitis: Misadventures with the operation of choice.Ann Surg. 1976; 183: 645
Radigan, L. R., Glover, J. L.: Barrett's esophagus. Arch surg In press
- Results of the combined fundic patch-fundoplication operation in the treatment of reflux esophagitis with stricture.Surg Gynecol Obstet. 1972; 135: 241
- Gastroesophageal reflux and hiatal hernia. Complications and therapy.J Thorac Cardiovasc Surg. 1967; 53: 21
- Comparison of crural repair and Nissen fundoplication in the treatment of esophageal hiatus hernia with peptic esophagitis.Ann Surg. 1971; 173: 782
Article info
Footnotes
☆Presented at the Thirty-fourth Annual Meeting of the Central Surgical Association, Buffalo, N. Y., March 3–5, 1977.
Identification
Copyright
© 1977 Published by Elsevier Inc.
