Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years.
The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients (58%) and alkali in 11 patients (39%). Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight
loss,
vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus (28%), whole esophagus (19%), and the mod esophagus (16%).
The operations performed were 17 (53%) ECG (esophagocologastrostomy), 5 (16%) PCG (pharyngocologastrostomy), 5 (16%) EG (esophagogastrostomy), 2 EJG (esophagojejunogastrostormy by free jejunal graft), and 1 case each of EJ (esophagojejunostomy),
esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients (72%), diseased esophaguses were resected, using transhiatal total esophagectomy in 15 (47%) and transthoracic partial esophagectomy in 8 (25%). Of those 23
patients, 3 patients (9.4%) were diagnosed as esophageal carcinoma on microscopic examination.
The postoperative most common complications were unilateral vocal cord palsy in 6 patients (19%), pneumothorax in 2 patients (6%). Late death occurred 8 months after the operation in one patient, which was associated with infection due to
anastomotic
leakage.
Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstructive surgery with
esophagectomy (transhiatal or transthoracic) for the esophageal stricture because it can avoid a chance of preventing cancer transformation.
(Korean J Thoracic Cardiovas Sung 1995;28:1032-7)
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