Benign esophageal strictures.

For the treatment of esophageal strictures caused by reflux, dilation alone is rarely curative, as a reflux is not prevented. Standard antireflux repairs are the 1st procedures to be used whenever possible. If esophageal damage and shortening is more severe, the Collis gastroplasty operation coupled with an antireflux repair is effective, but the selection of patients is important. The gastroplasty should not be used if the stricture cannot be dilated easily or if several previous operations have been performed at the cardia. If the Thal fundic patch operation is used, a skin graft and full fundoplication should be employed as well. The results from a fundoplication left in the chest are encouraging from initial reports. Further follow-up of all 3 of these approaches is required. For patients with the most difficult strictures, especially following multiple previous failed operations, resection of the stricture and intestinal interposition is the operation of choice.