[Gastric conservation in severe caustic lesions of the digestive tract: is it legitimate?].
OBJECTIVE
To evaluate advantages and drawbacks of a controlled conservative management of patients with severe gastric caustic injuries.


METHODS
Among 40 patients with severe caustic gastric burns (> IIb), 28 with stade III lesions (mosaic necrosis: n = 10, extensive or circumferential necrosis: n = 18) were managed prospectively from 1990 to 1998. Twenty-two patients had associated stage III oesophageal lesions and 6 had stage III duodenal lesions. All patients were followed up by daily surgical examination. Total gastrectomy with esophageal exclusion or stripping was performed in case of perforation.


RESULTS
Five immediate and 7 secondary total gastrectomies, two associated esophagectomies and two jejunal resections were performed. Mortality rate was 18% (5/28). Sixteen gastric preservations (60%) were achieved, including 7 complete and 9 partial because of gastric stricture. Eighteen esophagoplasties for oesophageal strictures or after gastrectomy were performed without mortality.


CONCLUSIONS
Stage III caustic injuries of the stomach, when they are not immediately life-threatening, do not systematically require total gastrectomy. A strict conservative attitude can be done with significant morbidity and acceptable mortality and significantly raises the numbers of preserved stomach.
Pruvot
F R
FR
Service de chirurgie digestive et transplantations, CHU--hôpital Claude-Huriez, avenue Michel-Polonovski 59037 Lille cedex, France. frpruvot@chru-lille.fr
Brami
F
F
Saulnier
F
F
Gambiez
L
L
Roumilhac
D
D
Chambon
J P
JP
Paris
J C
JC
Quandalle
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002057:Burns, Chemical / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D002424:Caustics / Q000009:adverse effects*; D004630:Emergencies; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D005773:Gastroscopy; D006801:Humans; D007583:Jejunum / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D009336:Necrosis; D018579:Patient Selection; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D013270:Stomach / Q000293:injuries* / Q000601:surgery*; D013369:Subphrenic Abscess / Q000209:etiology; D016896:Treatment Outcome
D002424:Caustics