[Surgical attitude in pre-pyloric stenosis due to corrosive substances. Intravascular segmental antrectomy in Y-V. Report of 80 cases (author's transl)].
The author reports 80 cases of gastric stenosis due to caustic substances, of which 20 were limited only to the stomach and 60 were accompanied by esophageal stenosis. In most cases (78.8 p. cent), the site of the gastric stenosis was antral, pre-pyloric and the duration of onset was, on average, 3 weeks. Surgical treatment depended on the extent of the corrosive lesions. In limited antral stenosis, we carried out antrectomy with gastroduodenal anastomosis. In pre-pyloric stenosis situated 3 to 5 cm from the pylorus, the author recommends conservation of the non-functioning pylorus by double pylorotomy and anastomosis with the whole of the border of the stomach, describing a personal procedure named intravascular Y-V segmental antrectomy. The criterion which decides the proximal border of the resection, should be the appearance of the gastric mucosa, the section should pass immediately above the caustic ulceration. In extensive gastric stenosis (more than 75 p. cent) of the stomach and in evolutive corrosive lesions, we recommend Y-shaped jejunostomy, of Maydl type. In post-caustic pre-pyloric stenosis we operated on 76 cases out of 80 with 3 deaths (3.9 p. cent mortality). In 25 patients we carried out esophagoplasty about 6 months after the accident. We preferred restrosternal isoperistaltic coloesophagoplasty by Kelling's procedure. To increase the circulation through the left colic artery and marginal artery, we ligatured the middle colic artery and right colic artery at the same time as the gastrostomy.
D000328:Adult; D002057:Burns, Chemical / Q000150:complications*; D002424:Caustics / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000601:surgery; D004940:Esophageal Stenosis / Q000139:chemically induced; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000139:chemically induced; D005774:Gastrostomy; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D011706:Pyloric Antrum / Q000601:surgery*; D011707:Pyloric Stenosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D011859:Radiography; D013272:Stomach Diseases / Q000601:surgery; D013997:Time Factors
D002424:Caustics
Attitude chirurgicale dans les sténoses pré-pyloriques post-caustiques. Antrectomie segmentaire intravasculaire en Y-V. Considérations sur 80 cas.