Asad Mehmud Malik, Abdul Hafeez Khan, Babar Khan, Humbal Bashir.
Surgical Bypass for Palliation of Carcinoma Esophagus.
Pak Armed Forces Med J Jan ;49(1):39-43.

Replacement of the esophagus remains a challenge for surgeons involved in treating esophageal diseases. Each of the available substitutes i.e.. stomach, colon and jejunum, have certain features that make them suitable for replacement of esophagus in certain circumstances. Proper patients selection, in depth understanding of available procedures and strict attention to pre and postoperative care, ensures the greatest chance for a successful outcome i.e. relief of dysphagia the leading problem in carcinoma esophagus. This is a prospective study of 22 patients with carcinoma esophagus, who presented at Combined Military Hospital (CMHI, Rawalpindi over a period of 18 months. The study shows that most of the patients presented late at a stage where disease was so advanced that only palliation could be possible. Operability was decided on the basis of clinical evaluation, barium studies, endoscopy ultrasonography and CT scan. Only 12 patients (n=22) (54.54%) could be offered any surgical procedure, and only in 2 (9.09%) some curative resection was possible, in 7 (31.81%) patients palliative resection was performed, with esophageal bypass and in 3 (13.6%) only by pass was possible. The statistical comparison of the two was non significant. The substitutes used to bypass esophagus included stomach, right and left colon and study showed right colon, when used, on technical ground gave better results. Post operative mortality was 16.6% and median survival 6.05 months.

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