Corrosive Esophageal Stricture Research Articles

Surgical management of upper cervical esophagus stricture caused by ingestion of corrosive substances – a single-center experience

Introduction and aim. Corrosive strictures of the upper cervical esophagus and hypopharynx are hard to treat in the operating room because there is a high chance of aspiration during swallowing after a high-up or proximal esophageal anastomosis. In this cases, we aimed to evaluate the role of intraoperative dilatation of the proximal hypopharyngeal and cervical esophageal stumps during surgery. Material and methods. Patients who underwent surgery and had upper cervical esophageal and hypopharyngeal strictures from corrosive substance ingestion were included. Results. Out of total 27 patients, 10 had a cricopharyngeal or proximal cervical esophageal stricture with a long segment tho racic esophageal stricture that was treated with intra-operative dilatation (IOD) of the proximal hypopharyngeal stump. IOD was done in two cases with Hegar’s dilator and in three cases with wire-guided Savary Gillard dilators. In 74% (20/27) of the cases, the colon was frequently used as an esophageal substitute, while the stomach was only used in 10 cases. On follow-up, none of them developed repeated aspirations or required a tracheotomy. Conclusion. IOD of the proximal hypopharyngeal and cervical esophageal stumps during surgery for corrosive upper cervi cal esophageal or cricopharyngeal strictures helps to save the proximal stump and avoid frequent hospital stays and multiple surgeries.

Malnutrition and Refeeding Syndrome: Report of Three Patients on Jejunostomy Feeding Following Corrosive Oesophageal Injury

Abstract Patients with alternative enteral access for corrosive oesophageal stricture are a particularly sensitive group of patients requiring dedicated nutritional care. The COVID-19 pandemic and the resulting lockdown, restrictions, financial constraints and delayed surgeries have resulted in nutritional deprivation. Many of these patients present late to healthcare institutions with severe malnutrition. Refeeding should be done carefully in them to prevent refeeding syndrome. Here, we describe the clinical course of three patients who were on jejunostomy feeds for corrosive injury of the oesophagus, developed feeding tube-related complications and presented with severe malnutrition during the COVID-19 pandemic.

Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children

To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.

First Robot-Assisted Ivor Lewis Operation with Manual Intrapleural Anastomosis for Corrosive Esophageal Stricture

Introduction. Esophageal pathology constitutes a small share in general morbidity, however, it remains highly relevant due to its social and clinical significance. Corrosive strictures account for a large proportion among benign esophageal diseases. Treatment of the disease starts with intraluminal surgery. However, it provides only short-term effect due to the tendency of esophageal strictures to restenosis. In case of treatment failure, esophagoplasty is performed. The esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis was performed in the BSMU Clinic. The abdominal and thoracic phases were performed using Da Vinci Si robotic surgical system. By the time of publication of this paper, the authors have gained experience of 15 successfully performed surgeries of this kind.Materials and methods. The paper presents a clinical case of robot-assisted esophagoplasty according to Ivor Lewis performed on patient Y., born in 1978, with the clinical diagnosis: corrosive strictures of the lower third of the esophagus with dysphagia of III–IV degree. The pathology developed as a result of surrogate alcohol consumption in September 2017. Since October 2017, the patient has been regularly treated in the Thoracic Surgery Unit of the BSMU Clinic, where she underwent a number of endoscopic surgeries, which appeared to provide a little effect. The patient underwent a subsequent surgical treatment including esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis using Da Vinci Si robotic system.Results and discussion. First three days of the postoperative period, the patient remained in the Anaesthesiology and Intensive Care Unit. She received step-by-step parenteral and enteral nutrition. Control fl uoroscopic examinations revealed timely, disturbances-free evacuation and no contrast leakage from the formed anastomosis. The patient was discharged on day 11 in satisfactory condition.Conclusion. Using Da Vinci robot-assisted system in Lewis esophageal plastic surgery has a number of specific features. It provides more precise tissue extraction with preservation of stomach and esophageal vessels, moreover, mobility of the instruments enables the key phase to be performed, namely — manual suturing in the esophagoanastomosis. As a result, the risk of postoperative complications is reduced.

317. A NOVEL TECHNIQUE OF ‘SUPERCHARGED ELONGATED GASTRIC TUBE’ FOR THE MANAGEMENT OF CORROSIVE PHARYNGEAL STRICTURE

Abstract Oesophageal reconstruction using various visceral conduits is the preferred treatment for the management of dysphagia secondary to corrosive oesophageal strictures. In patients with isolated oesophageal stricture colon and stomach are the most commonly used visceral conduits. However, management of patients with long oesophageal strictures with proximal extent at the hypopharynx is even more complicated. A long replacement conduit is required and most are managed by colopharyngoplasty. The options in patients who lack an available functional colon for esophageal replacement are very limited and may include a combination of gastric pullup with interposition free jejuna or myocutaneous flaps. These operations are complex and often require a two-stage approach. We herein describe a novel single stage approach of using ‘supercharged elongated gastric tube’ for esophageal replacement in a patient with unavailable colon.

Corrosive Esophageal Strictures: Alarming News for Gastroenterologists

Dysphagia is a common yet alarming symptom reported by patients during routine visits to outpatient clinics of gastroenterology. Most of them have a chronic history gastroesophageal reflux disease and use of proton pump inhibitors or anti reflux medications for years. The agonising part is that they are not referred by the physicians in the general practice. One of the major reasons behind this is persistent reluctance of patients to go for invasive investigations Gastroesophgeal reflus disease, achalasia ,hiatal hernia,benign esophgeal strictures, barrets esophagus and esophageal carcinoma are common causes of dysphagia. One of the causes which has been quite prevalent in our country is use of corrosives especially young girls and boys who are emotionaland depressed. They do something very outrageous in a moment which becomes a reason for regret for a long time .Corrosive esophgeal strictures isn’t that difficult got gastroenterology experts in normal circumstances but the cases can get complicated rarely including the risk of perforation in early stages of injury. Endoscopic dilatation either by Savory or TTS Balloon has been the cardinal line of management of corrosive strictures. They are done after necessary workup and investigations including barium swallow . The real dilemma is that patent develop complications like tracheoesophageal fistula after repeated dilatations. The length of follow up session are also difficult to determine with some centres opting for one weekly and others for two weekly sessions .Weekly sessions have been reported to ease off symptoms like dyphagia but causes higher risk of complications while in case of two weekly follow up there is enhanced risk of recurrence of symptoms and lesser complications.

Colonic transposition using mid colon for corrosive oesophageal strictures.

To evaluate mid colon as a viable alternative for reconstruction in diffuse corrosive oesophageal stricture compared to other modes. This is a prospective observational study of surgical management of corrosive oesophageal stricture using the colonic interposition graft. Eight patients were included for a period of 4years from January 2017 to December 2020 and followed up for a mean period of 32months (range of 24 to 46months). The results in these eight patients are discussed. A total of 8 patients underwent retrosternal oesophagocoloplasty and gastrojejunostomy. There was no intraoperative or hospital death. Postoperative complications included one patient each having aspiration pneumonia and anastomotic leak. A successful reconstruction can be done by securing the correct vascular pedicle and a technique of good anastomosis. From our experience, colonic transposition using mid colon as conduit can be considered as a viable alternative in patients with long segment oesophageal stricture.

A retrospective comparative study on stapler verses hand sewn technique in gastrointestinal anastomosis of twenty-five cases each

Background: In gastrointestinal surgery after resection of bowel loops, anastomosis of the bowel loops forms the main part of the surgery. The evolution of mechanical sutures by stapler devices is a technological advancement which helps anastomosis of bowel loops with less tissue injury and decreased time duration of procedure. Objective of current study was to compare the hand sewn anastomosis with stapler anastomosis in various types of elective gastrointestinal surgeries. Methods: A retrospective comparative study was conducted in department of general surgery at New Civil Hospital, Surat. The study included 50 patients of either gender and different age groups. Results: Out of 50 patients, 7 patients had Benign Gastric Outlet Obstruction (GOO), 18 patients had Post corrosive esophageal stricture, 5 patients had obstruction, 6 patients had post ileostomy status, 5 patients had carcinoma of ascending colon, 1 patient had carcinoma of caecum, 4 patients had ileo-caecal growth, 3 patients had carcinoma of descending colon, and 1 patient had sigmoid colon growth. In stapler anastomosis group Mean Total operative time was (156.20±45.21) mins whereas in handsewn anastomosis group Mean Total operative time was (188.40±48.32) mins with p value of 0.019. Conclusions: In this study, one distinct advantage of staplers was the consistent reduction in operating time. However, no significant difference was found between the stapler and hand-sewn groups with respect to other parameters such as restoration of intestinal function, postoperative hospital stay, and postoperative complications like leakage, fistula or stricture formation.

Outcomes of Resection Surgery in Corrosive Esophageal Stricture

Background: Esophageal stricture is a rarely encountered but a significant issue of worry throughout the world. Treatment options for esophageal stricture include endoscopic dilatation and surgery along with proton pump inhibitors. Surgery is performed if there is failure of enough dilatation and if recurrence occurs despite multiple dilatations. Objective: This study was designed to determine the outcome of resection surgery in adult patients presenting with Corrosive Esophageal Strictures. Material and Methods: A descriptive cross sectional study was carried out at surgery department, DHQ hospital Gujranwala, from December 2019 to June 2020. 60 consecutive patients, of age 20-60 years of either gender with presence of esophageal strictures caused by intake of corrosive substances and failed to undergo endoscopic dilatation due to difficulty in passing endoscope across the esophageal stricture, were included in the study. All study participants underwent resection surgery procedure under general anesthesia by a single surgical team. The marginal arcade alongside colon was conserved in all cases in which colon was utilized. Feeding jejunostomy was placed in all patients. Duration of surgery was noted. After surgery, patients were followed-up in surgical wards for 48 hours and examined on ultrasound for cervical anastomotic leak. Then patients were followed-up in OPD for 15 days and if dysphagia reoccurred, it was also noted. Results: The mean age of patients was 31.80 ± 7.74 years. There were 47(78.3%) male and 13(21.7%) female cases. There were 33.3% case who took acid, 16.7% took alkalis, 16.7% cases ingested metal salts, 21.7% had formalin, 6.7% cases had iodine tincture and 5.0% cases had other types of corrosive material. The mean operative time was 3.80 ± 0.80 hours. There were 11(18.3%) cases who had cervical anastomotic leak and 10(16.7%) cases had dysphagia related problem. No statistically significant difference (p≥0.05) was found in the outcomes of resection surgery across various groups based on age, gender, BMI, duration of corrosive intake, and type of corrosive substance ingested. Also, No significant difference (p≥0.05) was found in mean operative time in any stratum. Conclusion: It is concluded that outcome of resection surgery in adult patients presenting with Corrosive Esophageal Strictures was favorable with less complications. Hence these cases can be managed with standard surgical procedure to save their life and improve the quality of life. Keywords: Corrosives, Esophageal Stricture, Resection Surgery, Dysphagia, Cervical Anastomotic leak

503. TOTAL ESOPHAGECTOMY AND GASTRIC PULL UP FOR POST CORROSIVE ESOPHAGEAL STRICTURE: FEASIBLE IN MOST CASES WITH EXCELLENT OUTCOME

Abstract Post corrosive esophageal stricture represent a big national problem in Egypt because of bad culture of using (POTASH K2CO3) a highly corrosive substance for washing clothes with accidental (children) or sometimes suicidal (adult) swallow of this corrosive substance. Extensive esophageal stricture resulted is the late consequence of such swallow with complete or partial dysphagia leading to severe malnutrition and death of many patients. Dilation was successful in mild cases and many other cases required surgery. We present our new surgical strategy in managing 96 cases of post corrosive esophageal stricture including early feeding jejunostomy as well introduction of MI technique. From January 2016 to January 2022 ,96 cases of failed dilation post corrosive esophageal stricture were included in the study. Three- fields total esophagectomy and gastric pull up with cervical stapled esophago-gastric anastomosis was the operation used for all cases. Pyloroplasty and feeding jejunostomy were done for all cases We followed the cases for development of any complications (leak, bleeding, respiratory problems and stricture). Laparoscopy was used in 49 (51%) cases and was successfully completed in 42cases (86%). Right thoracotomy and left cervicotomy were used in all cases. Mean operative time was 368 minutes. Early complications were in the form of leak: cervical 12 cases (12.5%), from pyloroplasty 3 cases (3%). All cases managed conservatively. Only one pyloroplasty leak required exploration. Bleeding occurred in 5 cases (5%) and managed conservatively. Respiratory problems occurred in 37 cases (39%) requiring prolonged intubation in 3 cases (3%). Postoperative dysphagia was noted in 9 cases (9%) due to anastomotic stricture managed by dilation. No mortality recorded. Our short- and long-term results of total esophagectomy and gastric pull up for post corrosive esophageal stricture are excellent with low morbidity and no mortality.

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Objective: The objective of study was to determine the efficacy after endoscopic dilatation in patients of corrosive intake. Study Design: It was descriptive case series Setting: Research was conducted at Medical Unit-III, Services Hospital, Lahore. Duration: Duration of study was 6 months from 1st November 2016 to 30th April 2017. Material and Methods: This study involved 150 patients of age 18-65 years with corrosive intake and dysphagia score ≥ 2. A written informed consent was taken from each patient. Results: Total 150 patients were added in the study. Out of these, 118 patients (78.7%) were females while 32 (21.3%) were males. The age of patient ranged from 18 to 48 years with a mean of 26.72 ±5.61. One hundred thirty two patients (88 %) showed improvement in dysphagia while 18 patients (12 %) did not show any improvement. Efficacy calculated by chi- square test which showed p-value of .000 (statistically significant) Conclusion: 150 patients with dysphagia score ≥ 2 were added in study and dilated with Savary-Gilliard dilator. 132 patients showed improvement in dysphagia with p-value of .ooo (statistically significant).

Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures

Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures

Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center.

Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

RESULTS OF PREVENTIVE METHODS OF OCCURRENCE CERVICAL ANASTOMOTIC COMPLICATIONS IN ESOPHAGOPLASTY

The aim: The aim of the study was to improve the results of surgical treatment in patients with corrosive esophageal strictures using the designed comprehensive surgical management program in esophagoplasty to decrease cervical anastomotic complications. Materials and methods: The results of surgical treatment of 116 patients with esophageal strictures were studied. 45 patients had post-burn corrosive strictures, 17 – postoperative corrosive strictures, 10 - peptic strictures due to reflux esophagitis and 44 patients - esophageal cancer. All patients were divided into two groups: the control group, consisting of 55 patients who underwent conventional surgical treatment of corrosive esophageal strictures during 2005-2011, and experimental group involving 61 patients operated on during 2012- 2020, in whom an individual approach to the choice of surgical method was applied using diagnostic and treatment algorithm as well as the designed surgical management program. Results: In early postoperative period the proportion of specific and non-specific complications was significantly lower in experimental group as compared to the control group: cervical anastomotic leak - 16.36 % versus 4.392 %; strictures of cervical anastomosis – 20.0% versus 6.56 % (p&lt;0.05). There were six postoperative deaths - four in the control group and two in experimental group. Conclusions: To prevent the development of cervical anastomotic complications and mortality in esophagoplasty proper therapeutic approach with consideration of all prognostic criteria and risk factors should be chosen and designed surgical management program should be applied.

Perforations from Endoscopic Dilation of Corrosive Strictures in Adults: A Systematic Review and Meta-Analysis.

Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies. We aimed to evaluate its safety with regard to perforations and the effect of dilator type to perforation risk. A systematic review of published literature from inception to April 24, 2021, using PubMed and EMBASE databases was conducted. Studies in adult subjects (mean age ≥ 18years) reporting perforation rates of endoscopic dilation of corrosive esophageal and/or gastric strictures were included. Pooled cumulative perforation rates were computed as primary outcome. Secondary outcomes included, perforation with each dilator subtypes, surgical or conservative modes of management and mortality. Random effect meta-analysis was used to estimate the frequency of each of these outcomes. Variables were reported as percentages with 95% CI. A total of 712 subjects (N) who underwent 4840 dilations (n) were noted in the 15 studies that were included. Of which, eight were retrospective, while the remaining seven were prospective. On meta-analysis, the cumulative pooled perforation rate was 1% (1-2%) of the number of dilations (n%). The perforation rates with SG (1%, 0-3%) and balloon (1%, 0-5%) dilators were similar (p value < 0.01). 45/64 (59%, 11-94%) perforations were subjected to surgery while the remaining 14/64 (41%, 6-89%) was managed conservatively. Choice of management strategy was biased to the norms of the treating team. About 3/712 patients (0%, 0-2%) succumbed following perforation. Perforation from endoscopic dilation of corrosive strictures occurs rarely, and there is no significant difference in perforation risk related to the type of dilator.

Quality of life in patients of corrosive esophageal stricture treated with endoscopic dilatation.

Background and AimCaustic ingestion is associated with long‐term sequelae in the form of esophageal and/or gastric cicatrization requiring endoscopic or surgical intervention. Quality of life (QoL) and disability in patients with caustic‐induced sequelae is less explored.MethodsIn this prospective study, we included consecutive patients with symptomatic caustic‐induced esophageal stricture undergoing endoscopic dilatation. QoL was measured using the World Health Organization Quality of Life questionnaire (WHOQoL‐BREF). Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Subjective dysphagia score was calculated by Likert scale.ResultsA total of 42 patients were included in the study; 25 (59.5%) patients were male. Patients had poor WHOQoL‐BREF and WHODAS scores compared to normality data in all domains of the scores among both the genders. A majority (66.7%) of patients had a current psychiatric diagnosis, with the most common being mood disorder (50%) followed by suicidality (45.2%). Males had a higher prevalence of a previous psychiatric diagnosis compared to females, while females had a higher prevalence of suicidality. Dysphagia score had strong correlation with the WHOQoL (r = −0.66; P < 0.01) and WHODAS (r = 0.71; P < 0.01).ConclusionPatients with esophageal stricture due to caustic ingestion on long‐term endoscopic dilatation have poor QoL, high prevalence of psychological morbidity, and disability.

Alkaline substances gastroesophageal injury in young children: emphasis on Asian food preparation habits

Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication. We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil). Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority. Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial.

S0395 Outcomes of Benign Corrosive Esophageal Stricture Dilation—Single Center Experience

INTRODUCTION: The strictures secondary to caustic ingestion is a debilitating condition causing long-term nutritional challenges. This retrospective study investigates the outcomes of endoscopic dilation in patients with benign esophageal strictures secondary to corrosive ingestion. METHODS: A retrospective study that included patients with esophageal strictures due to caustic injury under follow-up was performed at a tertiary care center. These patients at the centre underwent endoscopic dilation by both Endoscopic Balloon Dilation (EBD) and Gilliard Savary (GS) dilators based on endoscopist comfort (P.K.). Symptomatic relief within 2 months of intervention was considered a successful response. RESULTS: The study included 39 patients including 31 patients with acid ingestion and 8 with alkali ingestion (Figure 1). Of patients with acid ingestion, 32.3% (10/31) underwent EBD and 67.7% (21/39) underwent GSD with only 50% (5/10) and 38.1% (8/21) respectively having symptom relief. Of patients with alkali ingestion, 50% (4/8) underwent EBD and 50% (4/8) underwent GSD with 75% (3/4) and 50% (2/4) respectively having symptom relief. Irrespective of caustic etiology, the composite success for EBD and GSD sub-groups were 61.5% and 38.5% respectively. Short stricture length was associated with successful outcomes among patients with acid ingestion (P = .003) but not among patients with alkali ingestion. Patients with failed outcomes had higher percentages of grade 2B and 3 mucosal injury at time of initial caustic exposure and warranted repeated endoscopic dilations for symptom management. This however did not reach significance in patients with either alkali (P = 0.19) or acid ingestion (likelihood ratio; P = 0.14). In the study population, seven patients had concomitant stomach involvement with three (7.7%) developing gastric outlet obstruction (GOO), all of whom underwent surgical intervention. Other than GOO, no other sequelae like achlorhydria, mucosal metaplasia, carcinoma or protein losing enteropathy were diagnosed during follow up. CONCLUSION: Overall success of endoscopic dilation for caustic esophageal stricture is limited and newer modalities like stent placement or endoscopic incision therapy may play a role in management of refractory strictures. Primary prevention of such injuries should be the preferred approach in managing this public health issue.Figure 1.: Flow diagram describing the endoscopic dilations among the patients with benign strictures.

176 SURGICAL MANAGEMENT OF CORROSIVE INJURIES OF ESOPHAGUS AND STOMACH—A 5 YEAR SINGLE CENTER EXPERIENCE

Abstract Corrosive injuries to the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's last 5-year experience in surgical management of corrosive injuries of oesophagus and stomach. Methods The aim of this study was to analyze the circumstance, demographic features, clinical findings and complications of caustic ingestion, the various surgical procedures performed and their short and long term outcomes. The records of 20 patients who underwent surgery for corrosive injuries of the oesophagus and stomach in our institution over a 5-year period (Jan2015-Dec2019) were retrospectively analyzed. Results Of 20 patients 13(65%) were accidental and 7(35%) were suicidal. Median age was 31 years with 75%males &amp; 25%females. Presenting complaints were weight-loss(95%), dysphagia(65%) &amp; vomiting(50%). Distributions of strictures were oesophageal, gastric or combined. 70% (N = 14) underwent feeding jejunostomy(FJ) as initial procedure. Isolated oesophageal strictures were managed by dilatation followed by gastric-pull through(N = 4)/coloplasty(N = 2). Isolated gastric strictures were managed Antrectomy (N = 5), distal/total gastrectomy (N = 2). Combined strictures were managed with coloplasty with antrectomy and Billroth I (N = 3) or coloplasty with Colo-jejunal anastomosis (N = 1). One patient underwent emergency esophagogastrectomy+cervical-oesophagostomy for perforation. Mortality rate was 15%(3/20). Conclusion Management of corrosive strictures varied between individual patients requiring a injury based surgery. Extensive injury with perforation, peritonitis or mediastinitis needed emergency surgery but associated with high mortality. Dilatation frequently failed in long segment strictures. High pharyngeal strictures were associated with higher morbidity. Isolated gastric strictures were easiest to manage. Corrosive strictures of oesophagus and stomach are difficult to manage and surgery has to be tailored according to site and extent of oesophageal/gastric stricture.

423 OUTCOME OF LAPAROSCOPIC SURGERY FOR THE MANAGEMENT OF CORROSIVE STRICTURE OF THE OESOPHAGUS

Abstract The surgical treatment for a corrosive stricture of the oesophagus, after failed endoscopic dilatation, often involves oesophageal replacement using a gastric or a colonic conduit. This is traditionally done via the conventional open approach. The objective of this study was to ascertain short and long term outcomes of Laparoscopic gastric (LGP) and colon pull up (LCP) for the treatment of corrosive stricture of the oesophagus Methods Retrospective study of patients of corrosive oesophageal stricture, who, following a failed endoscopic dilatation, underwent a laparoscopic gastric or colon pullup between Jan 2011 and November 2019. All patients were evaluated with an upper endoscopy/contrast study to determine upper level and extent of stricture. Stomach was the preferred conduit, colon was used when either stomach was involved in the scarring process or in high pharyngeal strictures. Early and late postoperative outcomes were ascertained. Results During the study period, 254 patients with corrosive stricture oesophagus were managed surgically. Of these 50 underwent LGP and 10 underwent a LCP and these formed the study group. Mean age was 22.4 (2–42) years. The mean operative time (174.6 ± 43 and 322 ± 63 min) and blood loss (58.6 ± 23.9 and 108 ± 30.8 mL) for LGP and LCP respectively. Four patients developed mild respiratory infection. Eight patients developed cervical anastomotic leak. One patient had a colojejunal leak and another leak from the gastric tube staple line which was managed with drainage and antibiotics. At a mean followup of 51 months all patients were euphagic. Conclusion Laparoscopic surgery for corrosive strictures of oesophagus is safe and provides good short and long term outcomes.