Esophageal reconstruction for hypopharyngoesophageal strictures after corrosive injury

Objective: To evaluate the surgical outcome of patients with caustic strict ure of the hypopharyngoesophagus. Materials and methods: During a 25-year p eriod, we performed esophageal reconstruction in 152 patients with diffuse or multiple caustic esophageal stricture. Of them, esophageal substitute wa s pulled up and anastomosed to the hypopharynx in 50 (33%) patients, and an astomosed to the cervical esophagus in the other 102 (67%) patients. Patien ts whose esophageal substitute anastomosed to the hypopharynx were enrolled to the present study. Among these 50 study patients, 13 underwent ablation of damaged organs and feeding jejunostomy in acute stage of corrosive inju ry, and the remaining 37 patients were initially organ preserved with or wi thout feeding gastrostomy or jejunostomy. Six patients had respiratory dist ress caused by laryngotracheal stricture. The ileocolon (28/50) was commonl y used as an esophageal substitute in reconstruction and most substitutes ( 43/50) went through the substernal route. Results: There was one operative death. Eight (16%) patients had major early postoperative complications. Si x patients underwent revision for late stenosis of hypopharyngeal anastomos is, and one redoing reconstruction using the jejunum because of failure of the transplanted ileocolon. Postoperatively, swallow function and maintaini ng body weight were considered good in 42 patients (84%) after an average o f 8 months follow-up. Five of six patients who underwent concomitant trache ostomy or laryngosurgery for laryngotracheal stricture got unsatisfactory r esult. The surgical outcome of the study patients was worse than that in pa tients with esophageal substitute anastomosed to a healthy cervical esophag us. In the later group of patients, 95/102 (93%) had good swallow function and only 7/102 (6.8%) had major early complications. Conclusions: Caustic s tricture of the hypopharyngoesophagus is a challenging reconstructive probl em. A successful reconstruction requires a correct hypopharyngeal opening a nd anastomosis, a good esophageal substitute, and a patent esophageal route and airway. (C) 2001 Elsevier Science B.V. All rights reserved.