Esophageal surgery in developing countries : our experience over 15 years.

In this clinical report, the author present s a series of 84 patientstreated over a 15 year-period. Males were predominant: 76/8, with asex ratio of almost 10M / 1F. Mean age was 51 (extremes : 21 and81 years ). Main causes were cancer (45/84); caustic stricture(26/84); esophageal trauma (9/84); peptic stricture by reflux (3/84)Therapeutic attitudes included: symptomatic medical treatmentwithout surgery for patients with advanced diseases, esophagealdilatations with or without Celestin tube insertion, permanent feedinggastrostomy or jejunostomy, modified Graviliu techniqueafter a partial esophagectomy for distal third resectable esophagealdisease, or a modified Belsey technique (to by-pass an unresectablelesion or a caustic stricture using the transverse colon)Results showed a 21% (20,83) mortality rate within a two-year follow-up with modified Gavriliu, 10% (9,67) with modified Belsey;77% (76,92) after esophageal dilatations, 82% (81,81) after feedinggastrostomy or jejunostomy, and 100% without surgical treatment.Factors of morbidity and mortality were mainly related with associatedinjuries (in trauma), bleeding, sepsis, malnutrition, cachexiaand the evolution of a malignant diseaseThe author pleads, in selected patients, for the use of modified Gavriliuand Belsey techniques in developing countries where oral dietis more available than other means and where esophageal stricturesfrequency is increasing.