Resection of oesophageal strictures

Abstract

Symptomatic gastro-oesophageal reflux can usually be managed non-operatively but, when stricture occurs, most informed physicians agree that an antireflux procedure is necessary. Nissen fundoplication has become the preferred operation for complicated reflux disease, and most strictures will resolve after control of reflux and two or three oesophageal dilatations. For those patients who have persistent stricture that is fibrotic, shortened, or does not respond to operative control of reflux, resection is indicated. Merendino and Dillard¹ proposed the use of a jejunal segment for interposition between the oesophagus and stomach because of its isoperistaltic nature, relative resistance to acid injury, and lack of reflux into the proximal oesophageal segment^2,3. Their study of both animals and humans demonstrated the jejunal segment to be the conduit of choice, and we have had long-term successful experience with its use⁴.