title: Outcome following surgical management of corrosive strictures of the esophagus.
abstract: OBJECTIVE
  To analyze the short- and long-term outcomes following surgical treatment for corrosive stricture of the esophagus.
  
  
  BACKGROUND
  Surgery is a well-established treatment for corrosive strictures of the esophagus and involves either resection or bypass of the damaged esophagus and replacement by a conduit. The need for resection and the choice of the ideal conduit for esophageal replacement in these patients continues to be debated and there are only a few studies reporting on the long-term outcome following the surgical treatment.
  
  
  METHODS
  This was a retrospective analysis of patients with corrosive stricture of the esophagus who were managed surgically between 1983 and 2009. The type of surgery performed (resection or bypass), the conduit used, the short- and long-term outcomes were assessed.
  
  
  RESULTS
  One hundred seventy-six corrosive strictures of the esophagus were managed surgically (resection: 64, bypass: 112). A transhiatal resection could be accomplished in 59 of 62 patients in whom it was attempted. Stomach conduits were used in 107 patients and colonic conduits in 69. The mean operating time was 4.3 ± 1.5 hours and the mean estimated blood loss 592 ± 386 mL. Cervical anastomotic leak occurred in 22 patients (12.5%). Follow up of more than 10 years was available for 78 patients (44.3%) and more than 15 years for 54 patients (30.7%). Recurrent dysphagia developed in 33 patients (18.7%). There were no differences in the short- or long-term outcomes in patients who underwent resection or bypass. The mean duration of surgery, intraoperative blood loss, incidence of conduit necrosis, and in-hospital mortality was significantly lower in patients with stomach conduits as compared with colonic conduits. There was a higher incidence of recurrent laryngeal nerve palsy, recurrent dysphagia, and aspiration after surgery in patients with strictures involving the upper end of the esophagus at or near the hypopharynx.
  
  
  CONCLUSIONS
  Satisfactory outcomes are achieved after surgery for corrosive strictures of the esophagus. Resection of scarred esophagus may be done without a substantial increase in the morbidity and mortality; however, the outcomes are not significantly different from bypass. Stomach is a good conduit and the colon should be reserved for cases where the stomach is not available. Long-term outcomes in patients with hypopharyngeal strictures, however, continue to be poor.
authors.affiliation: Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India. javedamitdr@gmail.com
authors.forename: Amit
authors.initials: A
authors.lastname: Javed
authors.forename: Sujoy
authors.initials: S
authors.lastname: Pal
authors.forename: Nihar Ranjan
authors.initials: NR
authors.lastname: Dash
authors.forename: Peush
authors.initials: P
authors.lastname: Sahni
authors.forename: Tushar Kanti
authors.initials: TK
authors.lastname: Chattopadhyay
mesh_terms: D000293:Adolescent; D000328:Adult; D002057:Burns, Chemical / Q000150:complications* / Q000601:surgery*; D002648:Child; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult