Reconstructive operations for esophagogastric corrosive lesions.
Corrosive esophagogastric lesions are common in Algeria and France. Within the past 14 years, our overall mortality has decreased to 6% as compared to 12% in the best results from elsewhere. This report describes our operative experience with 68 patients from 1974 to 1982. According to a prospective interdisciplinary program, lesions in 351 patients were staged by emergency esophagoscopic findings: Stage I, ulceration; Stage II, hemorrhage and ulceration; Stage III, mucosal necrosis, hemorrhage, and ulceration. Total parenteral nutrition or jejunal feeding was given to patients with Stage II lesions for 3 weeks and to those with Stage III lesions for 3 months before repeat esophagoscopy. Operations were required by 68 patients who had Stage III lesions and severe stenosis. Procedures done included 39 retrosternal colon interpositions, 11 partial or total gastrectomies, nine esophagogastrectomies, four esophagoenteral colonic bypasses, six esophagogastric colonic interpositions following partial gastric resection, and one gastrojejunostomy. Eleven of the cervical anastomoses were to the pharynx. There were no operative deaths and no anastomotic leaks. All patients have satisfactory nutrition and rehabilitation. Our operative experience in the preceding 5 years included an 11% mortality; improved results in the past 8 years are attributed to early and accurate staging, planned multidisciplinary management, good nutritional support, and better timing of operations. Stage III esophagogastric corrosive lesions may be treated within 4 to 5 months of injury with low mortality and good functional outcome.
D000293:Adolescent; D000328:Adult; D004935:Esophageal Diseases / Q000601:surgery; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged