Thoracoscopic approach for esophageal resection in chronic severe corrosive esophageal stricture: report of 2 cases.

OBJECTIVE

The authors reported the feasibility and safety of thoracoscopic approach for resection of the esophagus in two patients with diffuse corrosive esophageal stricture.

BACKGROUND

The unrelenting corrosive strictures of esophagus merit esophageal substitution. Because of the risk of complications in the retained esophagus, such as malignancy, mucocele, gastroesophageal reflux, and bleeding, esophageal resection is deemed necessary. Transthoracic approach for esophageal resection is considered safe but requiring thoracotomy. Transhiatal resection of a scared esophagus could be associated with serious complications. Less was known regarding the safety and feasibility of thoracoscopic resection of the esophagus in corrosive stricture of the esophagus.

MATERIAL AND METHOD: Thoracoscopic approach was used for mobilization of the scarred esophagus in two female patients. Laparotomy with colonic mobilization was performed in the second phase of the operation. Pharyngocolonic and esophagocolonic anastomosis were done via left neck incision in each patient. Intra-operative and post-operative complications were observed. Swallowing ability was assessed in the early postoperative period.

RESULTS

Thoracoscopic esophageal mobilization was successfully performed without complications. Any adhesions around the esophagus could be clearly seen and divided using harmonic scalpel under direct vision. Operative duration of the thoracoscopic part was 104 and 120 minutes and total blood loss was 320 and 350 ml respectively. Postoperative period was uneventful. The patient could have regular diet on day 8 and 9 after surgery.

CONCLUSION

Thoracoscopic approach for esophageal resection could be safely performed for the extirpation of diffuse esophageal stricture. Postoperative complication is being assessed in the authors' prospective trial.