ISSN 2398-2977      

Esophagus: resection and anastomosis

pequis

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.
  • Koenig J B, Silveira A, Cribb N C et al (2016) Clinical indications, complications, and long-term outcome of esophageal surgeries in 27 horses. Can Vet J 57 (12), 1257-1262 PubMed.
  • Whitfield-Cargile C M, Rakestraw P C & Hardy J (2013) Treatment of cervical oesophageal rupture in horses. Equine Vet Educ 25 (9), 456-460 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.

Other sources of information

  • Fubini S L (2019) Chapter 30: Esophagus. In: Equine Surgery. 5th edn. Eds: Auer J & Stick J. Saunders, USA. pp 474-496.

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