Esophagectomy for benign disease

Abstract

Esophagectomy for benign disease is uncommonly used but it is an important option to consider in those patients who have lost function of this organ. Esophageal resection is, in fact considered as a last resort for benign disease, after multiple failed conservative treatments, when the primary disease is not amenable to other treatments and the esophagus has become non-functional leading to very poor quality of life. The indications for esophagectomy for benign diseases can be divided into three major categories: obstruction, perforation and dysmotility. The process leading to organ failure and the need for resection for each specific disease will be discussed in an attempt to provide guidance as to when an esophagectomy is appropriate.

Keywords: Boerhaave’s syndrome; Esophagectomy; achalasia; benign esophageal disease; benign esophageal neoplasm; caustic ingestion; esophageal perforation; esophageal resection; esophageal stricture; gastroesophageal reflux disease (GERD).

Figure 1

Esophageal stent for benign stricture. The 16 mm × 70 mm ALIMAXX-ES fully covered stent under fluoroscopic guidance. The top of the stent was deployed at 17 cm and the top of the cricopharyngeal lines at 15 cm.

Figure 2

A 5-cm wide gastric tube created by dividing the stomach with multiple firings of a linear stapler to re-establish continuousness of alimentary tract after distal resection of the esophagus. The gastric conduit is completely mobilized and tubularized to ensure adequate length for the anastomosis.

Figure 3

Gross anatomy after esophagectomy for a large and symptomatic gastrointestinal stromal tumor (GIST) of mid esophagus.

Figure 4

Barium swallow showing end-stage achalasia, with typical bird’s beak aspect at the gastroesophageal junction and a large and sigmoid dilatation of the esophagus (megaesophagus). LPO, left posterior oblique.