Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture

Abstract

Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.

Keywords: Robotics; Laparoscopy; Surgery; Caustics; Bypass; Stricture

Core Tip: Most patients with corrosive esophagogastric stricture are young adults in the most productive period of their lives. Hence, minimally invasive surgery for corrosive stricture is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to complex operative steps. With advances in laparoscopic technology, there is a changing trend from laparoscopic-assisted approaches to totally minimally invasive techniques. However, assessing the patency of the vascular arcade remains a challenge during the laparoscopic approach. The challenges and limitations highlighted in the present review could guide future research on minimally invasive surgery in corrosive esophagogastric stricture.