title: The cervicosternolaparotomy approach for the treatment of graft dysfunction after retrosternal esophageal reconstruction for caustic injuries.
abstract: The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries.
  
  
  
  Patients who underwent cervicosternolaparotomy during revision surgery for graft dysfunction between 1999 and 2015 were included. Cervicosternolaparotomy was performed to mobilize and pull up the primary conduit during surgery for strictures (rescue cervicosternolaparotomy) or to allow retrosternal access for management of other graft-related complications (exposure cervicosternolaparotomy). Statistical tests were performed to identify factors associated with primary conduit preservation during rescue cervicosternolaparotomy.
  
  
  
  Fifty-five patients were included (28 men; median age, 43 years). Median delay between primary reconstruction and cervicosternolaparotomy was 15 months. Exposure cervicosternolaparotomy was performed in 12 patients (22%) for redundancy (n = 8), spontaneous perforation (n = 2), and caustic reingestion (n = 2). Rescue cervicosternolaparotomy was performed in 43 patients (78%) to treat supra-anastomotic (n = 11), anastomotic (n = 23), and diffuse (n = 9) stenosis. During rescue cervicosternolaparotomy, the primary conduit was preserved in 32 patients; median length gain obtained by transplant release was 8 cm. Failure to preserve the primary conduit was associated with previous surgical repair attempts (P = .003) and lack of initial concomitant pharyngeal reconstruction (P = .039). Two patients died (4%), and 35 patients (64%) experienced operative complications. Operative outcomes were similar after rescue and exposure cervicosternolaparotomy. With a median follow-up of 4.4 years, the functional success rate was 85%.
  
  
  
  Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France. Electronic address: thibault.voron@gmail.com.
authors.forename: Thibault
authors.initials: T
authors.lastname: Voron
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Anyla
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Corte
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Roland
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.affiliation: Department of General, Endocrine, and Digestive Surgery, Saint-Louis Hospital, AP-HP, Université Paris 7 Diderot, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000506:poisoning*; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D002424:Caustics
keywords: caustic injury; cervicosternolaparotomy; esophageal reconstruction; esophageal redundancy; esophageal stricture