Department of Gastrointestinal Surgery, GB Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India.
Surg Endosc. 2012 Nov;26(11):3344-9. doi: 10.1007/s00464-012-2307-3. Epub 2012 May 3.
Surgical management of corrosive stricture of the esophagus entails replacement of the scarred esophagus with a gastric or colonic conduit. This has traditionally been done using the conventional open surgical approach. We herein describe the first ever reported minimally invasive technique for performing retrosternal esophageal bypass using a stomach conduit.
Patients with corrosive stricture involving the esophagus alone with a normal stomach were selected. The surgery was performed with the patient in supine position using four abdominal ports and a transverse skin crease neck incision. Steps included mobilization of the stomach and division of the gastroesophageal junction, creation of a retrosternal space, transposition of stomach into the neck (via retrosternal space), and a cervical esophagogastric anastomosis.
Four patients with corrosive stricture of the esophagus underwent this procedure. The average duration of surgery was 260 (240-300) min. All patients could be ambulated on the first postoperative day and were allowed oral liquids between the fifth and seventh day. At mean follow-up of 6.5 (3-9) months, all are euphagic to solid diet and have excellent cosmetic results.
Laparoscopic bypass for corrosive stricture of the esophagus using a gastric conduit is technically feasible. It results in early postoperative recovery, effective relief of dysphagia, and excellent cosmesis in these young patients.
腐蚀性食管狭窄的手术治疗需要用胃或结肠导管替代瘢痕化的食管。传统上，这是通过传统的开放式外科手术来完成的。我们在此描述了首例使用胃管进行胸骨后食管旁路微创技术。
选择仅累及食管且胃正常的腐蚀性狭窄患者。手术采用仰卧位，患者取仰卧位，使用四个腹部端口和一个横向皮皱颈切口。步骤包括胃的游离和胃食管连接部的分离、胸骨后空间的创建、胃的胸骨后移位（通过胸骨后空间）以及颈部食管胃吻合术。
4 例腐蚀性食管狭窄患者接受了该手术。手术平均持续时间为 260（240-300）分钟。所有患者术后第一天均可下床活动，术后第 5-7 天可进流食。平均随访 6.5（3-9）个月，所有患者均能正常进食固体食物，且美容效果极佳。
使用胃管的腹腔镜旁路治疗腐蚀性食管狭窄在技术上是可行的。它可使患者在术后早期恢复，有效缓解吞咽困难，并为这些年轻患者提供良好的美容效果。
