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

Benign oesophageal stricture disease presents with slowly progressive dysphagia and minimal weight loss. Progression of the disease results in total dysphagia, malnutrition, and psychosocial complications that compel patients suffering from 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 gold-standard evaluation procedure. Transhiatal oesophagectomy, as opposed to the Ivor Lewis procedure, is the preferred corrective procedure because it avoids a thoracotomy and intrathoracic anastomosis. Gastric conduits are the conduits of choice, followed by colonic conduits. Jejunal conduit placement is technically challenging as it requires microvascular anastomosis techniques. Colonic conduits are preferred for 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 strictures 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 strictures by using both Ivor Lewis and transhiatal oesophagectomy procedures, performed at Ndola Teaching Hospital, Zambia.