Surgical management of acquired short esophagus with dilatable peptic stricture

Between 1964 and 1975, 175 patients were managed by gastroplasty combined with the Belsey Mark IV repair, for peptic stricture (87), esophagitis without stricture (25), recurrent hiatal hernia without stricture (25), incarcerated hiatal hernia (25), and primary motor disorder without stricture (13). Of the 175 patients, 163 (93%) were followed up from 1 to 13 years after repair. The clinical results obtained are good to excellent in more than 90% of the 175 patients. There was no postoperative mortality, morbidity is small, and no patient was considered to have such an unsatisfactory functional result as to warrant further surgery. A more critical and complete follow‐up of the first 33 patients operated on from the series of 175 confirmed these findings. With a 5‐to 13‐year follow‐up, 5 patients died of unrelated disease before the fifth postoperative year, 4 of whom were free of symptoms of stricture and reflux; 2 were lost to follow‐up, but were improved at last contact; 1 patient developed recurrent stenosis without evidence of esophagitis; 1 developed recurrent reflux due to peptic ulceration and pyloric stenosis; and 24 patients have no symptomatic reflux. The addition of gastroplasty to the Belsey Mark IV procedure is conceptually superior to some of the alternative operative procedures used in dealing with acquired short esophagus and stricture. However, a detailed, uniform reporting of long‐term follow‐up data and clearly defined case selection are necessary before an accurate and meaningful comparison of the results of various procedures can be accomplished.