title: Similar outcomes after primary and secondary esophagocoloplasty for caustic injuries.
abstract: BACKGROUND
  The main purpose of the study was to report a comparative experience with primary and secondary esophagocoloplasty for caustic injuries. Secondary esophagocoloplasty is the main rescue option after graft loss, but data in the literature are scarce.
  
  
  METHODS
  The operative characteristics, postoperative course, and functional outcomes of 21 secondary and of 246 primary esophagocoloplasty operations performed for caustic injuries between 1987 and 2006 were compared. Intraoperative events requiring significant changes in the planned operative strategy, such as graft ischemia or necrosis, were recorded. Statistical tests were performed in both cohorts to identify factors predictive of postoperative graft necrosis. Univariate analysis was performed to identify factors predictive of functional failure after secondary esophagocoloplasty.
  
  
  RESULTS
  Operative mortality (5% vs 4%, p=0.56), morbidity (62% vs 59%, p=0.96), postoperative graft necrosis (14% vs 7%, p=0.16), and functional success (68% vs 70%, p=0.79) rates of the secondary and primary esophagocoloplasty operations were similar. Intraoperative graft ischemia at the time of secondary esophagocoloplasty was significantly associated with the risk of postoperative graft necrosis (p=0.015) and functional failure (p=0.046). At the time of primary esophagocoloplasty, intraoperative necrosis of the colon was the only independent predictive factor of postoperative graft necrosis (p<0.0001).
  
  
  CONCLUSIONS
  Secondary esophagocoloplasty is a safe and reliable salvage option after primary graft loss in patients with caustic injuries. Delayed esophagocoloplasty should be considered if intraoperative colon necrosis occurs at the time of primary reconstruction.
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Paris 7 Diderot, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.forename: Helene
authors.initials: H
authors.lastname: Vuarnesson
authors.forename: Sarah
authors.initials: S
authors.lastname: Zohar
authors.forename: Matthieu
authors.initials: M
authors.lastname: Faron
authors.forename: Bruno
authors.initials: B
authors.lastname: Halimi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz Bongrand
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000209:etiology* / Q000601:surgery*; D002424:Caustics / Q000633:toxicity*; D003106:Colon / Q000637:transplantation*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D002424:Caustics