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Ann Thorac Surg 2002;73:349
© 2002 The Society of Thoracic Surgeons

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Correspondence

Durability of the intercostal muscle pedicle

^a University of Medicine & Dentistry of New Jersey, 142 Palisade Ave, Ste 100, Jersey City, NJ 07306, USA

To the Editor

I have used the intercostal muscle pedicle as a sling and without tightness for prevention of gastroesophageal reflux after Ivor Lewis resection [1] in over 100 patients to date. The long-term follow-up of patients who had malignancy (18%) was as much as 25 years. The patients who had benign stricture were also followed-up for more than 4 to 28 years. Dilation was performed one to three times in the first postoperative year and rarely thereafter. One 25-year survivor of cancer had to be dilated every 7 to 8 years. She had somewhat firm anastomosis but the dilation with Maloney mercury bougies was quite easy. All these patients and a few patients with tracheobronchial resection or esophageal diverticulectomy plus intercostal pedicle reinforcement, never had serious or severe stricture. None presented with the necessity for resection. All the previously described patients had hand-sewn anastomoses. One patient who had a circular stapler anastomosis had to be resected for severe stricture a few weeks after the initial operation and before enough time elapsed for ossification or calcification to occur.

We have not found it necessary to apply silver nitrate to the pedicle to avoid ossification or calcification.

It is hard to imagine how an intercostal pedicle around a rigid tracheobronchial structure may cause stricture even by ossification. On the other hand, a smaller bronchus such as the middle lobe bronchus could easily become strictured even without pedicle around it, given the well known propensity for stricture of tracheobronchial anastomoses [2].

I tend to agree with Dr Stanley Fell’s comment, in the Discussion section of Deeb and colleagues’ latter [2] article, that the advantages far outweigh any possible disadvantage of the intercostal myoneurovascular pedicle.

References

1. Demos N.J., Kulkarni V.J., Taha S. Control of postresection gastroesophageal reflux by intercostal pedicle esophagogastropexy. Dis Esophagus 1995;8:142-144.
2. Deeb M.E., Sterman D.H., Shrager J.B., Kaiser L.R. Bronchial anastomotic stricture caused by ossification of an intercostal muscle flap. Ann Thorac Surg 2001;71:1700-1782.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nicholas J. Demos Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Demos, N. J. Search for Related Content PubMed Articles by Demos, N. J. Related Collections Chest wall Related Articles