Postoperative esophageal complications--prevention and treatment

Postoperative esophagitis and stricture formation may be more serious than the disease for which operation was done. The best treatment is prevention by avoiding use of a nasogastric tube if possible. If it has to be used, the tube should have a small lumen and be removed as soon as possible.When surgical operation is necessary, the cardioesophageal junction should not be sacrificed unless it is absolutely necessary to do so.Conservative treatment if begun early can minimize or prevent the development of esophagitis and subsequent stricture formation.

Mucosal tears at the oesophagogastric junction (the Mallory-Weiss syndrome)

This is a re-appraisal of the supposedly rare Mallory-Weiss syndrome in which 11 patients with mucosal tears at the oesophagogastric junction are described. The fact that these cases were collected from general hospitals within a short period suggests that the condition is more common than supposed and may account for a considerable proportion of the 20 to 25% of patients with upper gastrointestinal bleeding in whom no radiological abnormality can subsequently be found. Of the 11 patients, eight presented with gastrointestinal bleeding, two with mediastinitis, and one without relevant symptoms. The classical history of antecedent vomiting before the bleeding was obtained in only four patients, its absence not excluding the diagnosis. The presence of a small hiatal hernia in four patients appeared to predispose to mucosal tears as did mucosal atrophy occurring with advancing age. Some experimental findings pertaining to the mechanism of the tears are presented.

The closing mechanism between stomach and oesophagus and its importance in surgery of the gastrooesophageal junction

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Esophageal hiatal hernia; some aspects of surgical treatment

Patients with esophageal hiatal hernia often have an array of distressing complaints and physical signs that are difficult to interpret. Physiologic and anatomic studies of the gastroesophageal area in the region of the esophageal hiatus of the diaphragm indicate the existence of a three-in-line sphincter group, consisting of the inferior esophageal constrictor, diaphragmatic pinchcock and cardioesophageal junction. These mechanisms, acting in unison, prevent regurgitation in normal persons.It also can be deduced from clinical, radiologic and experimental data that anatomic disturbances at the esophageal hiatus account for physiologic alterations. A reasonable explanation for the symptoms and signs of esophageal hiatal hernia can be made on the basis of the functional competence of the three-in-line sphincter mechanisms.