title: Colopharyngoplasty for the treatment of severe pharyngoesophageal caustic injuries: an audit of 58 patients.
abstract: OBJECTIVE
  The aim of this study was to describe the technique of colopharyngoplasty for the reconstruction of concomitant esophageal and pharyngeal caustic injuries and to evaluate the postoperative course and late functional outcomes.
  
  
  BACKGROUND
  Surgical treatment of esophageal and pharyngeal strictures is a difficult challenge because reconstruction at this level interferes with the mechanisms of deglutition and respiration. Several techniques have been described for the treatment of this condition but none is accepted as the gold standard.
  
  
  METHODS
  Fifty-eight patients (34 men, median age 37 years) underwent colopharyngoplasty for caustic injuries between 1993 and 2005. Forty patients (69%) had a previous psychiatric history of depression (n = 30) or schizophrenia (n = 10). After removal of all scar tissues, the pharyngeal reconstruction was performed with the cervical end of the colic transplant employed for esophageal replacement. Laryngeal resection was associated in half of the patients. Success of the procedure was defined as recovery of nutritional autonomy and airway patency.
  
  
  RESULTS
  Operative mortality was 2%. Postoperative complications required reoperation in 16 patients (28%). The functional outcome was evaluated in 46 patients with a follow-up of more than 6 months. The tracheostomy was withdrawn in 42 (91%) patients after a median of 42 days (range, 20-1020). The jejunostomy was removed in 32 patients (70%) after a median of 12 months (range, 2-54). Finally, the procedure was successful in 31 patients (67%). Logistic regression analysis showed that advanced age, a previous history of psychiatric disease, and early reoperation had an adverse impact on fuctional outcome. Seven patients (12%) repeated the suicide attempt.
  
  
  CONCLUSIONS
  Colopharyngoplasty is a simple and reliable procedure that can be successfully employed to restore the digestive continuity in patients with concomitant esophageal and pharyngeal caustic injuries. Control of the underlying psychiatric disease before reconstruction is a key factor for success.
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.forename: Cécile
authors.initials: C
authors.lastname: de Chaisemartin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Goasguen
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: Sarah
authors.initials: S
authors.lastname: Zohar
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Brette
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D002424:Caustics / Q000633:toxicity*; D003106:Colon / Q000637:transplantation*; D004947:Esophagus / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010614:Pharynx / Q000293:injuries* / Q000601:surgery*; D013406:Suicide, Attempted; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D002424:Caustics