The chapters in this section are focused on benign, cystic, congenital, and traumatic lesions of the esophagus (Fig. 37-1). When compared with gastroesophageal reflux and malignant esophageal disease, benign tumors, congenital cysts, and esophageal trauma are relatively uncommon.
Esophagus, anterior view.
Chapter 38 describes the most common congenital malformations of the esophagus that require surgical correction in infants and children. These include esophageal atresia, tracheoesophageal fistula, esophagotracheal cleft, hiatal hernia, vascular rings, and indications for esophageal replacement. Today, most of these entities can be corrected, and a child can lead a normal life after surgery.
Chapter 39 reviews benign tumors and cystic lesions of the esophagus. Benign tumors of the esophagus make up 1–2% of all esophageal neoplasms. However, while benign tumors and cysts account for less than 2% of all esophageal lesions, they reportedly account for up to 10% of all surgically resected esophageal lesions.1 Esophageal cysts include congenital and acquired lesions and are secondary either to persistent vacuoles that remain within the esophageal wall during embryologic development or to obstruction of the excretion ducts within esophageal glands. The former generally present in the early childhood years, whereas the latter present later in adult life.
Since most benign and cystic lesions are asymptomatic and do not interfere with normal esophageal function, it is no surprise that these tumors are most often discovered incidentally. In the past, most such lesions were noted at the time of other interventions. Now they are discovered more commonly on unrelated imaging studies. For lesions that do cause symptoms, the etiology typically is intraluminal obstruction or external compression secondary to a mass effect. Functionally oriented classification systems are based on location within the esophagus (i.e., intramural, submucosal, or intraluminal) and are useful clinically because they can be related to the specific presentation, diagnosis, and expected treatment. Although most of these lesions are asymptomatic, often the location within the esophageal wall is most responsible for the specific symptoms. Since benign lesions are greatly outnumbered by malignant lesions, it is advantageous to perform a comprehensive preintervention evaluation to define the nature of the lesion. In general, most benign esophageal tumors and cysts are located in the middle and lower thirds of the thoracic esophagus. Leiomyoma is the most commonly described lesion and constitutes 65% of all benign esophageal masses. Despite their benign nature, these lesions typically are resected when recognized. Surgical excision offers excellent results in terms of ease of resection, functional outcomes, and durability.
Traumatic esophageal disorders comprise several groups of injuries including iatrogenic and noniatrogenic (i.e., spontaneous blunt or penetrating and chemical or caustic) trauma. Practical approaches to managing esophageal trauma are often dictated by the nature of the underlying injury and the experience and preference of the surgeon. Consequently, although many of the same principles and techniques may apply, ...