INCIDENCE AND MANAGEMENT OF BENIGN ANASTOMOTIC STRICTURE AFTER CERVICAL ESOPHAGOGASTROSTOMY

Benign anastomotic stricture after transhiatal oesophagectomy and gast ric tube reconstruction constitutes a major problem. From August 1988 to April 1991, 81 patients were followed after cervical oesophagogastr ostomy. Twenty-four patients (30 per cent) developed a benign anastomo tic stricture 3-23 (median 8) weeks after operation. Poor vascularizat ion of the gastric tube, determined during operation, and postoperativ e anastomotic leakage were statistically significant risk factors for stricture formation. Symptoms related to stricture were often typical and were confirmed by endoscopy and/or radiography. Radiography did no t yield information additional to that obtained from endoscopy. Strict ures were treated in the outpatient clinic by dilatation with Savary d ilators. Repeated dilatation completely alleviated dysphagia in 20 of the 24 patients (83 per cent). In ten patients dilatations could be di scontinued after a median of 8 (range 1-17) sessions. Dilatation was c ontinued until the end of follow-up in nine patients or until death fr om recurrent disease in five. No complications of dilatation were seen .