DOI: http://dx.doi.org/10.18203/2349-2902.isj20205891

Study of definitive surgical management of patients with corrosive stricture of upper gastrointestinal tract

Bina Vaidya, Meet Desai, Tejas Patel, Chirag Tulsiyani, Rajkumar Singh, Rohit Sesodia

Abstract


Background: Corrosive injury of the oesophagus and stomach is a cause of major morbidity and mortality and is usually seen in the younger age group. Although definitive surgical procedures are available, there is a considerable debate on the timing of a definitive surgery and its electiveness. This study aims to document the benefits of elective surgery and the outcomes of various surgical procedures.

Methods: A retrospective observational study of 25 cases of corrosive stricture of upper gastrointestinal tract who underwent definitive surgical procedure was conducted in the department of general surgery at the new civil hospital and government medical college, Surat during a period of 60 months from July 2014 to July 2019. Patients were followed up till a period of 6 months post definitive surgical procedure and were evaluated.

Results: Out of 25 patients in our study subjected to definitive surgical procedure in the form of either gastrojejunostomy (GJ) or colonic transposition, 18 patients (72%) could take fully oral and required no further intervention till 6 months post-operative follow up; 3 patients (12%) due to post-operative oesophageal stricture required serial 3 monthly oesophageal dilatation with controlled radial expansion (CRE) balloon; 4 patients (16%) had expired.

Conclusions: The choice of definitive surgical procedure according to the level of oesophageal stricture and its optimal timing gives good outcomes with less morbidity and mortality in patients with corrosive substance ingestion.


Keywords


Corrosive stricture, Oesophagus, Gastrojejunostomy, Colonic transposition

Full Text:

PDF

References


Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterol. 1989;97(3):702-7.

Haller JA Jr, Andrews HG, White JJ, Tamer MA, Cleveland WW. Pathophysiology and management of acute corrosive burns of the oesophagus: results of treatment in 285 children. J Pediatr Surg. 1971;6(5):578-84.

Hugh TB, Kelly MD. Corrosive ingestion and the surgeon. J Am Coll Surg 2000;190(1):102.

Cabral C, Chirica M, De Chaisemartin C, Gornet JM, Munoz-Bongrand N, Munoz-Bongrand N et al. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc. 2012;26(1):214-21.

Guarino S, Shobayo F, Qureshi YA, Daley F, Alaraimi B, Patel B. Upper abdominal exenteration: a lifesaving procedure following caustic ingestion. Dig Liver Dis. 2014;46(4):386-7.

Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956-2006. Clin Toxicol (Phila). 2007;45(4):402-8.

Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive oesophageal strictures. Gastrointest Endosc. 1999;49(4):509-13.

Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign oesophageal strictures secondary to corrosive ingestion. Dis Oesophagus. 2016;29(8):1027-31.

Wang RW, Zhou JH, Jiang YG, Fan SZ, Gong TQ, Zhao YP et al. Prevention of stricture with intraluminal stenting through laparotomy after corrosive oesophageal burns. Eur J Cardiothorac Surg. 2006;30(2):207-11.

Okonta KE, Tettey M, Abubakar U. In patients with corrosive oesophageal stricture for surgery, is oesophagectomy rather than bypass necessary to reduce the risk of oesophageal malignancy? Interact Cardiovasc Thorac Surg. 2012;15(4):713-5.

Gvalani AK, Deolekar S, Gandhi J, Dalvi A. Antesternal colonic interposition for corrosive oesophageal stricture. Indian J Surg. 2014;76(1):56-60.

Boukerrouche A. Left colonic graft in esophageal reconstruction for caustic stricture: mortality and morbidity. Dis Esophagus. 2013;26(8):788-93.