SURGICAL-MANAGEMENT OF BENIGN STRICTURE FROM REFLUX ESOPHAGITIS

From January 1976 to December 1994, out of 605 patients with reflux oe sophagitis, 166 (27.4 %) presented with an oesophageal stricture, and 68 of these (40.9 %) underwent surgical therapy. Thirteen of the 68 pa tients (19.1 %) had an associated Barrett's oesophagus. Oesophageal ma nometry revealed scleroderma in nine individuals (13.2 %). The strictu re was undilatable in 11 patients (16.1 %) observed before 1985. An oe sophageal-sparing operation was performed in the majority of patients: fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), and total duodenal diversion (n = 4). Oesophageal resection was performed in 15 patients (22 %); 12 of these individuals were operated on before 1985. The mortality rate was 4.4 %: two patients died of ne crosis of the interposed colon and one of acute pancreatitis. The aver age follow-up time was 27 months (8-136). Oesophageal-sparing procedur es significantly reduced the need for further endoscopic dilatation (P < 0.001). Standard fundoplication was successful in 30 out of 39 pati ents (77 %). Reasons for a failed fundoplication were a long, hard str icture, an ineffective partial wrap in patients with unrecognized shor t oesophagus, or underlying scleroderma. Regression of Barrett's mucos a was not recorded with any of the conservative surgical procedures.