Management of severe caustic stenosis of the hypopharynx and esophagus by ileocolic transposition via suprahyoid or transepiglottic approach. Analysis of 18 cases.

Abstract

Eighteen cases of severe chronic caustic stenosis of the hypopharynx and esophagus are presented. Restoration of digestive continuity was accomplished by retrosternal ileocolic transposition. The cervical approach and the position of anastomosis depended on the status of the hypopharynx. When one pyriform sinus remained open (type I, N = 4), an anterior suprahyoid approach was used in conjunction with lateral hypopharyngotomy because it facilitated the anastomosis and additional minor surgical procedures. When the hypopharynx was completely stenosed (type II, N = 14), a transepiglottic approach consisting of partial horizontal laryngectomy was used because it allowed excision of the supraglottic stricture, restoration of the oropharyngeal cavity, anastomosis to the posterior oropharyngeal wall, management of an eventual laryngotracheal stenosis, and elevation of the laryngeal inlet above the digestive anastomosis. After operation, several endoscopic examinations were required, sometimes combined with reoperation. Return of deglutition assuring normal nutrition was obtained in 61% of patients: 3 of 4 type I and in 8 of 14 type II.