title: Esophagojejunostomy after total gastrectomy for caustic injuries.
abstract: The objective of the study was to compare outcomes of emergency esophagogastrectomy (EGT) and total gastrectomy with immediate esophagojejunostomy (EJ) in patients with full-thickness caustic necrosis of the stomach and mild esophageal injuries. After caustic ingestion, optimal management of the esophageal remnant following removal of the necrotic stomach remains a matter of debate. Between 1987 and 2012, 26 patients (men 38%, median age 44 years) with isolated transmural gastric necrosis underwent EGT (n = 14) or EJ (n = 12). Early and long-term outcomes of both groups were compared. The groups were similar regarding age (P = 0.66), gender (0.24), and severity of esophageal involvement. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Emergency morbidity (67% vs. 64%, P = 0.80), mortality (17% vs. 7%, P = 0.58), and reoperation rates (25% vs.14%, P = 0.63) were similar after EJ and EGT. One patient (8%) experienced EJ leakage. One patient in the EJ group and 13 patients in the EGT group underwent esophageal reconstruction (P < 0.0001). Aggregate in hospital length of stay was significantly longer in patients who underwent EGT (median 83 [33-201] vs. 36 [10-82] days, P = 0.001). Functional success after EJ and EGT was similar (90% vs.69%, P = 0.34). Immediate EJ can be safely performed after total gastrectomy for caustic injuries and reduces the need of further esophageal reconstruction.
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Chirica
authors.forename: A
authors.initials: A
authors.lastname: Kraemer
authors.forename: E
authors.initials: E
authors.lastname: Petrascu
authors.forename: H
authors.initials: H
authors.lastname: Vuarnesson
authors.forename: B
authors.initials: B
authors.lastname: Pariente
authors.forename: B
authors.initials: B
authors.lastname: Halimi
authors.forename: N
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: E
authors.initials: E
authors.lastname: Sarfati
authors.forename: P
authors.initials: P
authors.lastname: Cattan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000633:toxicity*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013270:Stomach / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002424:Caustics
keywords: caustic ingestion; esophagogastrectomy; esophagojejunostomy; total gastrectomy