Page 130 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 9 · Surgery of the oesophagus

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(a) (b) (c)
Oesophageal stricture in a 6-year-old Domestic Shorthaired cat with a 6-month history of regurgitation that had begun after an anaesthetic
9.5 episode. (a) The endoscopic image shows a stricture in the caudal thoracic oesophagus. (b) Endoscopic view of balloon dilation of the
stricture. (c) Endoscopic view immediately following balloon dilation.
(Courtesy of the Veterinary Imaging Database, University of California, Davis)

whereas bougienage exerts longitudinal shearing forces hampered by limited mobility of the vascular pedicle. Free
that could predispose to oesophageal perforation. The microvascular grafts of colon or small intestine can be
reported success rates of both techniques are comparable utilized to replace the cervical oesophagus. In experimen-
and either technique can result in oesophageal perfora- tal dogs, replacement of the thoracic oesophagus with
tion. Most animals will require multiple dilations. free grafts has been largely unsuccessful. Numerous bio-
Oesophageal stenting has also been described for materials have been studied in laboratory animal models
treatment of benign oesophageal strictures that were for use in humans; however, these materials are not com-
refractory to dilation and medical management. In a case mercially available for clinical use.
series of 10 dogs, all experienced short-term improvement
in dysphagia; however, the complication rate was high
(Lam et al., 2013). Prognosis
Most dogs and cats with oesophageal strictures can be
Surgery improved with repeated bougienage or balloon dilation
treatments, although they may continue to regurgitate
Surgery is associated with a high incidence of stricture periodically or have mild dysphagia with an inability to eat
recurrence and oesophageal incisional dehiscence, and is
dry food. The major complications of stricture dilation
only indicated for the treatment of strictures that fail to are perforation and recurrence of clinical signs.
respond to dilation or bougienage, or for cases in which
perforation occurs during dilation. Surgical options for
treatment of strictures include:
Intra- and postoperative
• Simple oesophagoplasty
• Oesophageal resection and anastomosis management of oesophageal
• Patch oesophagoplasty
• Oesophageal substitution. surgical cases
After oesophageal surgery, the cervical region or thorax
Simple oesophagoplasty involves a longitudinal oesopha -
gotomy that is closed transversely. Most oesophageal should be lavaged thoroughly. If an oesophageal perfora-
tion was present, the surgical site should be swabbed
strictures are too extensive to be treated by oesopha-
goplasty or oesophageal resection and anastomosis. prior to closure and bacteriological culture and antimicro-
Oesophageal patching involves a longitudinal oesophagot- bial sensitivity testing performed. A thoracostomy tube
omy through the stricture and incorporation of an ‘in-lay’ should be placed if the thoracic cavity was entered. Food
patch in the closure of the defect to increase the luminal and water are withheld for a period determined by the
diameter. Tissues that have been used for in-lay patches extent of the surgery. After oesophagotomy or other less
include pericardium, local muscle flaps (sternothyroid, inter- invasive oesophageal procedures, food in the form of a
costal or diaphragmatic muscle), stomach and intestine. gruel-type diet can be introduced 24–48 hours after sur-
Oesophageal substitution can be performed following gery as long as the animal is not regurgitating. The diet is
extensive oesophageal resection, although clinical experi- gradually returned to normal after 7 days. After oesopha-
ence in dogs and cats is very limited. The cervical oesoph- geal resection and anastomosis, fluid and nutritional
agus can be replaced in a multistage procedure with an requirements should be provided through a gastrostomy
inverse tubed skin graft or an omocervical cutaneous or enterostomy tube for at least a week.
island axial pattern flap. Various muscle grafts have been Postoperatively, animals should be observed carefully
used experimentally in dogs for complete segmental for 2–3 days for signs of oesophageal leakage, which
reconstruction of the oesophagus. The caudal thoracic include cervical pain, swelling, dyspnoea, regurgitation
oesophagus can be replaced by gastric advancement and and elevated rectal temperature. Animals can be placed
oesophagogastric anastomosis. Oesophageal replace- on an H 2 receptor blocker or proton pump inhibitor
ment with a small intestinal or colonic pedicle graft is and a sucralfate slurry to limit gastric fluid acidity and

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