[Palliative surgery of esophageal cancer in Djibouti: the value of colonic esophagoplasty].

Because of delayed diagnosis in Black Africa, esophageal cancer is often seen at an advanced stage when dysphagia is total and eating becomes impossible. At this stage, palliative surgery is the only alternative to enable the patient to eat. Over a 27 month period in Djibouti, palliative therapy for esophageal cancer was indicated in 49 patients and surgery was performed in 37 of these patients. Out of 26 patients to whom gastrostomy was proposed, there were 12 that refused and 14 who underwent the procedure with a mean survival of 40 days. Esophageal bypass was performed in 23 patients. In 22 of these patients, the procedure was colon interposition and in the remaining case a gastric tube was used. There was one postoperative death. Excluding 3 patients that suffered cervical fistulas and one patient who required redo to remove a textiloma, postoperative recovery was uneventful. Patients resumed eating and were able to return home less than one month after the procedure. This study demonstrates that colon interposition can be performed in Black Africa despite limited availability of preoperative and postoperative intensive care facilities. It is a useful alternative for the management of malignant and benign stenosis.