Benign Esophageal Disease

The treatment of benign esophageal disease – including complex cases – is a major strength of Washington University general thoracic surgeons.

In many cases, these surgeons correct benign esophageal conditions laparoscopically – typically resulting in less pain and scarring and a shorter recovery time for the patient than open procedures. They also perform a high volume of open surgeries for benign esophageal disease.

Conditions treated by Washington University thoracic surgeons include:

Hiatal hernia with gastroesophageal reflux disease
Achalasia
Esophageal diverticular disease (Zenker’s diverticulum, epiphrenic diverticulum)
Benign esophageal strictures

Hiatal Hernia With Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a condition in which gastric contents from the stomach backflow into the esophagus. The esophagus is not made to resist acid, and so the acid burns the esophagus, causing the symptom of heartburn.

No one knows what causes GERD, but a hiatal hernia may contribute to the condition. A hiatal hernia occurs when the upper part of the stomach protrudes through the diaphragm, the muscle wall that separates the stomach and the chest. Normally, the diaphragm helps the lower esophageal sphincter prevent acid from entering the esophagus. When someone has a hiatal hernia, it is easier for acid to come up into the esophagus.

Surgery becomes an option when medicine and lifestyle changes aren’t successful or when those options aren’t reasonable alternatives. A Nissen fundoplication is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the lowest point of the esophagus to prevent acid reflux and repair a hiatal hernia.

In the case of a large hiatal hernia, the esophagus often becomes shortened. Washington University thoracic surgeons specialize in a procedure to lengthen the esophagus – called a Collis gastroplasty – that helps reduce the recurrence rate of GERD after repair of a large hiatal hernia.

Collis gastroplasty and Nissen fundoplication are performed as both open and laparoscopic procedures.

Learn more about Nissen fundoplication
Learn more about GERD 

Achalasia
Achalasia is a rare disorder of the esophagus characterized by a progressive inability to swallow. It occurs when the esophageal muscles become progressively weaker and eventually stop working at all. In addition, the lower esophageal sphincter never completely opens, so that food does not enter the stomach easily. These two problems cause increased difficulty in swallowing and may lead to vomiting, weight loss, malnutrition and dehydration.

A surgical procedure called the Heller myotomy is the treatment of choice for achalasia, offering long-term symptomatic relief. The procedure weakens the faulty muscles at the gastroesophageal junction, allowing the valve between the stomach and the esophagus to remain open so that food and liquid can pass into the stomach.

Learn more about Heller myotomy

Diverticular Disease of the Esophagus
Diverticular disease of the esophagus (an abnormal pouch opening from the esophagus) can affect both the upper and lower end of the organ.

Zenker’s diverticulum: This is an abnormal pouch in the upper part of the esophagus. It can allow food to become trapped, causing bad breath, irritation, difficulty in swallowing and regurgitation.

An operation performed by Washington University thoracic surgeons relieves the symptoms of patients with Zenger’s diverticulum.

Epiphrenic diverticulum: This diverticulum occurs at the lower end of the esophagus. Retention of undigested food can result in regurgitation, difficulty swallowing and abdominal or chest pain.

This condition can be treated through either an open operation or a laparoscopic procedure, depending on the patient’s condition.

Benign Esophageal Stricture
Benign esophageal stricture is a narrowing of the esophagus that can be caused by GERD, viral or bacterial infections, injuries caused by endoscopes or other conditions or injuries. Symptoms may include difficulty swallowing, pain with swallowing, regurgitation and unintentional weight loss.

Washington University thoracic surgeons perform dilation (stretching) of the esophagus as the preferred treatment for stricture.

Surgeons who treat benign esophageal disease:

Bryan F. Meyers, MD, MPH
Traves D. Crabtree, MD
Daniel Kreisel, MD, PhD
Alexander S. Krupnick, MD
G. Alexander Patterson, MD
Varun Puri, MD 

For a patient appointment, call (888) 287-8741 or (314) 362-6025.