Management of corrosive esophageal burns in 149 cases.
OBJECTIVE
We sought to present our experience in the management of esophageal burns.


METHODS
From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy.


RESULTS
Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets.


CONCLUSIONS
Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.
Zhou
Jing-Hai
JH
Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China.
Jiang
Yao-Guang
YG
Wang
Ru-Wen
RW
Lin
Yi-Dan
YD
Gong
Tai-Qian
TQ
Zhao
Yun-Ping
YP
Ma
Zheng
Z
Tan
Qun-You
QY
D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000209:etiology / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004940:Esophageal Stenosis / Q000517:prevention & control*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015607:Stents; D013524:Surgical Flaps; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome
D002424:Caustics