“A difficult but rewarding task”

Continuing my previous story, this is a summary of my experience in treating patients suffering from burnt gullets / stomach which includes in brief the surgical procedures used to relieve their suffering by replacing the burnt gullet with another segment of the digestive tract illustrated with photographs and X rays.

Unable to take in the required nourishment for survival these patients were in a poor state of health at the time of admission to the ward suffering for varying periods of time. Some had undergone treatment in other hospitals without much relief while others were admitted with complications. Careful and meticulous attention to detail to optimise their health prior to surgery was an essential requirement.  These included the following:

• Correction of  any underlying  nutritional deficiencies
• Treating any complications related to previous procedures
• Assessing the suitability for a major surgical procedure
• If the oral route could not be used to feed adequate quantities we introduced a tube to the stomach / small bowel to feed them prior to surgery. This enabled special high energy liquid feeding

The non surgical method of treatment that had been used in these patients is called dilatation of the stricture (narrowing). This procedure had been used in many patients, sometimes on multiple occasions without much improvement. The old and the new techniques are described below in brief.

The old technique of dilating a stricture using a rigid oesophagoscope

“JUST IMAGINE A RIGID BRASS TUBE BEING PUSHED DOWN YOUR THROAT”

The new technique – Flexible gastro-oesphageal video endoscopy

The success of this procedure depended on many factors

The most important were;

• The type of stricture and the site
• The number of strictures
• The involvement of stomach

The type of strictures in gullet and stomach

The majority of the patients who were admitted to my ward at SJGH had undergone many procedures such as repeated dilatations which have not been successful in providing a lasting benefit. In such cases the only option was either to remove the ‘burnt gullet’ and replace it or by-pass the damaged gullet with another segment of the digestive tract either the colon or the stomach. Removing and replacing the damaged gullet was the better option.

Many techniques have been used by surgeons. The technique that I used is described briefly without going into much detail.

REMOVAL OF THE DISEASED GULLET (OESOPHAGUS)

THE NEXT STAGE OF THE OPERATION IS THE REPLACEMENT OF THE GULLET THAT IS REMOVED WITH EITHER THE

• LARGE BOWEL (COLON) OR THE
• STOMACH

Those who are interested in reading more on this subject are advised to refer to my PUBLICATION in this website titled

SURGICAL MANAGEMENT OF BENIGN STRICTURES OF THE OESOPHAGUS: 18 YEARS OF EXPERIENCE (click here to view the post)

I would also like to draw your attention to two more stories related to this subject

From darkness to light (Click here to view the post)

Silva back at his “wheel” (Click here to view the post)