The surgical treatment of combined corrosive pharyngeal and oesophageal stricture

Abstract

A personal experience of reconstruction in 6 patients with combined pharyngeal and oesophageal corrosive stricture is reported. Oesophagectomy was performed in all patients and reconstruction was with whole stomach in 5 patients. In the sixth patient, the stomach was destroyed by corrosive and reconstruction was attempted by colon interposition but this proved unsuccessful. In the 5 patients with pharyngogastrostomy, postoperative recovery was smooth without any instance of anastomotic leakage and swallowing was restored. Recurrent dysphagia occurring in the first two patients was due to construction of too narrow an anastomosis. Recurrent dysphagia did not occur in the subsequent 3 patients in whom a large pharyngogastrostomy anastomosis was established to the posterior pharyngeal wall. Minor tracheal aspiration occurred, but even in the 2 patients with associated laryngeal injury, the symptoms subsided once swallowing was restored. Regurgitation was a problem only in one patient who developed gastric stasis; however the symptoms subsided after pyloroplasty. Reconstruction of pharyngo-oesophageal stricture by pharyngogastrostomy restores almost normal swallowing provided that laryngeal function is adequate and a large pharyngogastrostomy is established.