Colopharyngoplasty for intractable caustic pharyngoesophageal strictures in an indigenous African community--adverse impact of concomitant tracheostomy on outcome.
OBJECTIVE
Surgical management of caustic strictures of the upper digestive tract poses difficult challenges. This is because reconstruction above the cricopharyngeal junction interferes with the mechanisms of swallowing and respiration. This report reviews the outcome of colopharyngeal reconstruction of severe diffuse pharyngoesophageal caustic strictures in an indigenous African community.


METHODS
The medical records of patients who underwent colopharyngoplasty from January 2006 to December 2008 were retrospectively reviewed to obtain information on patients' demographics, surgical technique and outcome.


RESULTS
In the study period, 20 patients underwent reconstruction for caustic esophageal strictures; in five (three males, two females) colopharyngoplasty was required. Their ages ranged from four to 56 years (mean 25 years). Follow-up ranged from 23 to 94 months (mean 33 months). Colopharyngoplasty using left colon tunneled retrosternally was performed in all patients. Rehabilitative training for deglutition was required for 0.5-5.0 months postoperatively to restore near-normal swallowing in all patients. However, tracheostomy complications caused two deaths (one early, one late) and varicella encephalitis caused another late death.


CONCLUSIONS
In this African community, colopharyngoplasty provided an effective mean of restoration of upper digestive tract continuity in patients with severe caustic pharyngoesophageal strictures. Tracheostomy in this setting portends a significant long-term mortality risk.
National Cardiothoracic Centre, Korle Bu Teaching Hospital, Box KB 846 Korle Bu, Accra. Ghana. mawut@mail.com
Mark
M
Tettey
Frank
F
Edwin
Ernest
E
Aniteye
Martin
M
Tamatey
Kow
K
Entsua-Mensah
Ernest
E
Ofosu-Appiah
Kwabena
K
Frimpong-Boateng
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002057:Burns, Chemical / Q000209:etiology / Q000601:surgery*; D002424:Caustics / Q000633:toxicity*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003106:Colon / Q000637:transplantation*; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000208:ethnology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000139:chemically induced / Q000601:surgery*; D010614:Pharynx / Q000293:injuries / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
D002424:Caustics