Benign oesophageal disease: 4 cases managed at a teaching hospital in Ndola, Zambia

Benign oesophageal stricture disease presents with slow progressive dysphagia and minimal weight loss. Progression of the disease results in total dysphagia, malnutrition and psychosocial complications that compel patients suffering this condition to seek an oesophagectomy as their last definitive treatment option. Upper gastrointestinal (GI) endoscopy with tissue biopsy and barium swallow are important for evaluating the sequelae of oesophageal stricture disease, with endoscopy being the golden standard evaluation procedure. Transhiatal oesophagectomy, as opposed to the Ivor Lewis, is the preferred corrective procedure because it avoids a thoracotomy and intrathoracic anastomosis. The preferred conduit is gastric followed by the colon. Jejunal conduit is technically challenging as it requires microvascular anastomosis techniques. Colon conduit is preferred in those patients with lesions above the T1 vertebra or more proximal strictures, and those with expected long-life survival because the colon undergoes differential growth. Reconstructive procedures for patients with benign oesophageal stricture are not common in poorly resourced settings. In Zambia, such patients have historically been managed with feeding gastrostomies and/or referred abroad for reconstructive surgery. In this article, we present our maiden experience of reconstructive surgical management of benign oesophageal stricture by using both Ivor Lewis and transhiatal oesophagectomy procedures, performed at Ndola Teaching Hospital, Zambia.