Does the state of the upper esophageal sphincter influence the choice of esophageal substitute ?

M.B. Orringer (Ann Arbor)

It is an extremely important technical point to emphasize that the state of the upper esophageal sphincter prior to esophagectomy and esophageal reconstruction is of critical importance in planning the operation. The patient with esophageal spasm may complain of « globus » type symptoms, and some of these unfortunate patients will have undergone a cervical esophagomyotomy prior to an « attack » on their thoracic esophagus. If the upper esophageal sphincter has been rendered incompetent by a previous cricopharyngeal myotomy, massive gastroesophageal reflux with resultant aspiration may follow a cervical esophagogastric anastomosis, and therefore, a colon interposition is a far better option in these patients [1].

If the upper esophageal sphincter, however, in a patient requiring esophageal resection for neuromotor dysfunction is intact, my preferred approach is a cervical esophagogastric anastomosis in the original esophageal bed. Proper construction of the cervical esophagogastric anastomosis is an important factor in the functional success of the operation [2].

References

1. Orringer MB (1985) Transhiatal esophagectomy for benign disease. J Thorac Cardiovasc Surg 90: 649-655.

2. Orringer MB, Stirling MC (1988) Cervical esophagogastric anastomosis for benign disease

functional results. J Thorac Cardiovasc Surg 96 : 887-893.