BENIGN ANASTOMOTIC STRICTURES AFTER TRANSHIATAL ESOPHAGECTOMY AND CERVICAL ESOPHAGOGASTROSTOMY - RISK-FACTORS AND MANAGEMENT

Benign stricture formation at the cervical anastomosis after transhiat al esophagectomy with gastric tube interposition is an important sourc e of morbidity, In a large group of patients (n = 269) who had undergo ne transhiatal esophagectomy with gastric tube interposition, we exami ned surgical and nonsurgical risk factors for the development of benig n strictures at the cervical anastomosis, In addition, we evaluated th e results of endoscopic bougie dilation in patients in whom an anastom otic stricture developed, Results: During follow-up, 114 patients (42% ) had a benign anastomotic stricture, Only a history of cardiac diseas e (p = 0.03), postoperative leakage at the anastomosis (p = 0.002), an d a stapled rather than a hand-sewn anastomosis (p = 0.04) were found to be independent risk factors for the development of a stricture. In 27 of 60 patients with anastomotic leakage, contrast swallow examinati on demonstrated only a leak at the anastomosis. Endoscopic bougie dila tion of anastomotic strictures was successful in 78% of patients after a median of three dilation sessions (range 1 to 28), In 3% of patient s dilations were still being performed, and 19% of patients had died b efore normal swallowing had been achieved, In two of 519 (0.4%) dilati on sessions a major complication occurred. Conclusions: (1) Patients w ith preoperative cardiac disease are at an increased risk for anastomo tic stricture, (2) Even in patients having no symptoms, a contrast swa llow can detect anastomotic leakage that results in an increased risk for the development of anastomotic strictures, (3) The benefit of the stapler device for anastomosis remains to be determined, (4) Endoscopi c bougie dilation with the patient mildly sedated is a safe and effect ive method for the treatment of anastomotic strictures.