Abstract
Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures a limited Billroth I resection (in 9) or conversion a prior precolic GEA in such anastomosis (in 5) and middle or total gastrectomies (in 3) were performed. A second stage substernal by-pass with isoperistaltic transverse colon segment was done 6 - 12 weeks later. In all but one instances the graft was implanted high in the gastric stump. In extensive burned and retracted such lesion (in 3) a similar by-pass was carried out but the lower anastomosis was done with the not involved prepyloric segement. In concomittant antropyloric and esophageal strictures in 11 young, good risk patients, a limited Billroth I resction and simultaneous colonic bypass was used. In case of accompanied respiratory fistula (in 4) exclusion by-pass was useful for both lesions. The associated pyloric stricture (in 3) was solved at the same time. Side-to-end pharyngocolostomy was used in 4 high thoracocervical strictures. In 8 previously perforated strictures the by-ass was performed 2 months later. Reults: The overall mortality was 4%. The postoperative morbidity was low (8%). All cervical leaks closed spontaneously. Particular late complications required revisional surgery in 12, 5% of cases. Conclusion: In complicated corrosive strictures (esophageal, gastric, fistulas) limited Billoth I resection, isoperistaltic colon by-pass with high gastrocolic anastomosis, good gastric drainage and maintenance of the duodenum in gastrointestinal continuity are the main factors to achieve the best functional results.
Highlights
And late consequences of corrosive injury may involve several segments of upper gastrointestinal tract
A lot of publication have been dedicated to main aspects of colonic esophageal replacemet only few studies [1]-[4] are avaible on the surgical strategy in such multiple strictures
All patients were relived from dysphagia and epigastric dyscomfort.In a normal time they have resumed a diet without restriction, expect spicy food
Summary
And late consequences of corrosive injury may involve several segments of upper gastrointestinal tract. We were faced with pathologically and clinically 6 different patterns: 1) After chemical trauma, gastric emptying disturbance was the most common complication, which required to be managed whithin 2 month. Nine of such 17 patients underwent limited Billroth I resection with or without gastrostomy, but never earlier 6 weeks after injury (Figure 1). The remaining 5 cases were transferred with GEA or Billroth II resection and established esophageal stricture. In these unfavorable condition for esophageal reconstruction, the first step was conversion of previous gastric operation into Billroth I one (Figure 2). In all 17 cases, except one, for associated and intractable esophageal sticture (Figure 3) a substernal by-pass with isoperistaltic transverse colon segment was done, implanted high in the gastric stump
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