Equis ISSN 2398-2977

Esophagus: resection and anastomosis

Contributor(s): Graham Munroe, Prof Jonathon Naylor

Introduction

  • Esophageal stricture   Esophagus: stricture  is secondary to previous internal trauma, eg foreign body or feed impaction (choke)   Esophagus: impaction  , external neck trauma, esophageal rupture   Esophagus: trauma  or post-esophageal surgery   Esophagus: esophagotomy    Esophagus: esophagostomy  .
  • Stricture formation is usually an annular lesion classified according to the anatomic location of spasm, induration and fibrosis:
    • Acute strictures - may resolve with conservative management (soft, ground, diet).
    • Chronic strictures - may require surgical management including partial or complete resection and anastomosis.

Uses

  • Treatment of esophageal strictures >60 days old where the muscularis is extensively damaged (complete resection) or confined to the submucosa/mucosa (partial tunica)   Esophagus: stricture  .
  • Ruptured esophagus where the muscular layer is necrotic   Esophagus: trauma  and the proximal and distal segments can be anastomosed without undue tension.

Advantages

  • Partial resection - less chance of wound breakdown in esophagus.
  • Surgical treatment of choice for chronic strictures.

Disadvantages

  • Limited length of esophagus to permit re-opposition   →   tension on suture line.
  • Damage to surrounding structures.
  • Requires general anesthesia (GA)   Anesthesia: general - overview  .

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • For esophageal strictures: good if only mucosa affected; deeper damage is more difficult to resolve and may scar   →   fibrous stricture.
  • Guarded: partial resection.
  • Poorer: complete resection and anastomosis.
  • Recurrence of stricture post-surgery   →   poor prognosis.
  • Mortality up to 75%.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Craig D & Todhunter R (1987) Surgical repair of an esophageal stricture in a horse. Vet Surg 16 (4), 251-154 PubMed.
  • Suann C J (1982) Oesophageal resection and anastomosis as a treatment for oesophageal stricture in the horse. Equine Vet J 14 (2), 163-164 PubMed.
  • Stick J A, Derksen F J & Scott E A (1981) Equine cervical esophagostomy; complications associated with duration and location of feeding tubes. Am J Vet Res 42 (5), 727-732 PubMed.


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