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Pemmada V, Shetty A, Nedunchezhian S, Bhat G. Antesternal colonic interposition. BMJ Case Rep 2023; 16:e254304. [PMID: 37147108 PMCID: PMC10163415 DOI: 10.1136/bcr-2022-254304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
- Vikas Pemmada
- Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Athish Shetty
- Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Suriya Nedunchezhian
- Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Bhat
- Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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2
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Andreollo NA, Tercioti Jr V, Coelho Neto JDS, Ferrer JAP, Lopes LR. Caustic stenosis of the esophagus and malignant neoplasia: A dilemma. Front Oncol 2022; 12:1059524. [DOI: 10.3389/fonc.2022.1059524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
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3
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Long term outcome of a subcutaneous colonic interposition after pharyngo-laryngectomy for strictures of the larynx and hypopharynx resulting from caustic ingestion: A case report. Int J Surg Case Rep 2022; 95:107215. [PMID: 35609478 PMCID: PMC9126773 DOI: 10.1016/j.ijscr.2022.107215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022] Open
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4
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Varshney VK, Nayar R, Balakrishnan S, Birda CL. Robotic Ivor-Lewis Esophagectomy for Corrosive-Induced Esophageal Stricture. Cureus 2022; 14:e23738. [PMID: 35509761 PMCID: PMC9057448 DOI: 10.7759/cureus.23738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Corrosive-induced stricture of the esophagus is associated with long-standing morbidity. Though required in particular situations, esophagectomy circumvents the long-term complications of the remnant scarred native esophagus. We performed a robotic Ivor-Lewis esophagectomy for corrosive esophageal stricture and demonstrated its feasibility for the same. A young male patient presented with a history of caustic ingestion, leading to a long segment stricture in the lower third of the esophagus. He developed absolute dysphagia, which was refractory to endoscopic dilatation. A robotic approach was utilized to create a gastric conduit followed by intrathoracic esophagogastric anastomosis. He had a smooth postprocedure course, was discharged on a soft diet on the seventh postoperative day, and is doing well after six months of follow-up. The robotic Ivor-Lewis approach can be safely performed for corrosive esophageal stricture, akin to esophageal malignancy. Besides the comfort of performing the procedure, especially intra-thoracic anastomosis, it helps alleviate the chances of mucocele formation and sequelae of cervical neck anastomosis.
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5
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Nayar R, Varshney VK, Goel AD. Outcomes of Gastric Conduit in Corrosive Esophageal Stricture: a Systematic Review and Meta-analysis. J Gastrointest Surg 2022; 26:224-234. [PMID: 34506024 DOI: 10.1007/s11605-021-05124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes, morbidity, and complications associated with it. METHODS MEDLINE, Cochrane Library, and Google Scholar (January 1960 to May 2020) were systematically searched for all studies reporting short- and/or long-term outcomes and complications following the use of a gastric conduit for corrosive esophageal stricture. RESULTS Seven observational studies involving 489 patients (53.2% males, mean age ranging from 22.1 to 41 years) who had ingested a corrosive substance (acid in 74.8%, alkali in 20.7%, and unknown in the rest) were analyzed. Gastric pull-up was performed in 56.03% (274/489) of patients. Median blood loss in the procedure was 187.5 ml with a mean operative duration of 298.75 ± 55.73 min. The overall pooled prevalence rate of anastomotic leak was 14.4% [95% CI (6.2-24.0); p < 0.05, I2 = 67.38], and anastomotic stricture was 27.2% [95% CI (13-42.8); p < 0.001, I2 = 80.11]. Recurrent dysphagia according to pooled prevalence estimates occurred in 14.4% patients [95% CI (5.4-25.1); p < 0.05, I2 = 69.1] and 90-day mortality in 4.8% patients [95% CI (1.5-9.1%); I2 = 31.1, p = 0.202]. The dreaded complication of conduit necrosis had a pooled prevalence of 1.3% [95% CI (0.1-3.4%); I2 = 0, p = 0.734]. CONCLUSION The stomach can be safely used as the conduit of choice in corrosive strictures with an acceptable rate of complications, postoperative morbidity, and mortality.
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Affiliation(s)
- Raghav Nayar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India.
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tustumi F, Seguro FCBDC, Szachnowicz S, Bianchi ET, Morrell ALG, da Silva MO, Duarte AF, de Sousa JHB, Laureano GG, da Rocha JRM, Sallum RAA, Cecconello I. Surgical management of esophageal stenosis due to ingestion of corrosive substances. J Surg Res 2021; 264:249-259. [PMID: 33839340 DOI: 10.1016/j.jss.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. METHODS A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. RESULTS In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. CONCLUSION Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
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Affiliation(s)
- Francisco Tustumi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Sérgio Szachnowicz
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Edno Tales Bianchi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Luiz Gioia Morrell
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Matheus Oliveira da Silva
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - André Fonseca Duarte
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gabriela Gomes Laureano
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
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7
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Mu HW, Chen CH, Yang KW, Pan CS, Lin CL, Hung DZ. The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study. PLoS One 2020; 15:e0243922. [PMID: 33373373 PMCID: PMC7771858 DOI: 10.1371/journal.pone.0243922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41–3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29–3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52–4.18) than those without pesticide/detergent intoxication. Conclusion: In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.
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Affiliation(s)
- Han-Wei Mu
- Division of Toxicology, China Medical University Hospital, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Chen
- Division of Toxicology, China Medical University Hospital, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Wei Yang
- Division of Toxicology, China Medical University Hospital, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Syuan Pan
- Division of Toxicology, China Medical University Hospital, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office of Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Dong-Zong Hung
- Division of Toxicology, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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8
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Anand U, Kumar R, Priyadarshi RN, Parasar K, John AG. An Unusual Postoperative Complication of Retrosternal Gastric Pull-Up for Corrosive Esophageal Stricture. Cureus 2020; 12:e12323. [PMID: 33520521 PMCID: PMC7837637 DOI: 10.7759/cureus.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Retrosternal gastric pull-up with side-to-side esophagogastric anastomosis is the surgery done for corrosive esophageal stricture unresponsive to endoscopic dilatation. This surgery is considered safe in terms of morbidity. Complications due to leak from distal esophageal staple line as a result of partially patent bypassed esophageal lumen have never been reported with this surgery. Herein, we report a case in which a leak from distal esophageal staple line resulted in intraabdominal fluid collection, a life-threatening complication. This complication necessitated a second surgery that involved exclusion of the native esophagus at the neck.
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Affiliation(s)
- Utpal Anand
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | - Ramesh Kumar
- Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | | | - Kunal Parasar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | - Aaron G John
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
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Okugbo SU, Anyanhun GA, Efobi CA, Okugbo OT. Presentation and management outcome of childhood corrosive oesophageal injury in Benin City. Afr J Paediatr Surg 2020; 17:74-78. [PMID: 33342838 PMCID: PMC8051635 DOI: 10.4103/ajps.ajps_90_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes. AIMS AND OBJECTIVES This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018. MATERIALS AND METHODS This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and studied for epidemiological, clinical and operative procedures and outcome. RESULTS A total of 49 patients were seen and admitted during the period under review. Male (29) : Female (20) ratio was 1:1.4 Mean age was 4.7±4.8 years with a range of 1-16years, The males presented earlier and had worse strictures as well as more surgical procedures. Caustic soda preparations ingested more (93.9%), all ingestions were within the household setting, and all had first aid given by way of oral palm oil. Only two (4.1%) ingested acids with only one flat battery ingestion. 45.5% of the patients had dilatation only and of these 50% recovered after 3 sessions and required no more sessions. A further 50% were lost to follow up. 38.8% had oesophageal replacement with colon following oesophagectomy. CONCLUSION In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.
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Affiliation(s)
- Stanley U Okugbo
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - G A Anyanhun
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - C A Efobi
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - O T Okugbo
- Department of Basic Science, Benson Idahosa University, Benin City, Nigeria
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Spontaneous Perforation of a Malignified Corrosive Stricture of the Esophagus and Subsequent Perforation of a Giant Duodenal Stress ULCUS. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Surgical interventions for corrosive stricture of the esophagus are extremely difficult and technically challenging. In this manuscript, we present a patient with esophagectomy due to perforation of a corrosive stricture of the esophagus that underwent malignant transformation and subsequent perforation of a giant duodenal stress ulcus, which occurred 12 days after the intervention. We performed a total esophagectomy, pharyngo- and gastrostomy, suture of the duodenal perforation but the postoperative period was challenging and despite our efforts, the patient died on the 50th postoperative day due to respiratory and renal failure.
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11
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Nayar R, Varshney V, Suman S, Soni S, Kumar N. Thoracolaparoscopic-Assisted Esophagectomy for Corrosive-Induced Esophageal Stricture. Cureus 2020; 12:e7909. [PMID: 32494524 PMCID: PMC7263410 DOI: 10.7759/cureus.7909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Corrosive-induced stricture of the digestive tract is a dreaded complication following corrosive ingestion. When surgical reconstruction is needed, esophagectomy helps to avoid the long-term complications related to leaving behind the scarred native esophagus. We tried to ascertain the feasibility and safety of a thoracolaparoscopic-assisted esophagectomy in such a setting. A 32-year-old male presented with corrosive-induced esophageal stricture that lead to progressive dysphagia not amenable for endoscopic dilatation. Thoracoscopic approach was used for mobilization of the scarred esophagus under vision. Laparoscopic approach was used in mobilizing the stomach and creating a conduit. Esophagogastric anastomosis was performed in the neck. The patient had an uneventful recovery postoperatively and was discharged after six days on a semisolid diet. Thoracolaparoscopic-assisted esophagectomy can be safely performed for corrosive strictures of the esophagus. Besides improving the ease of performing the procedure, it also helps mitigate the morbidity associated with conventional open surgery in such cases.
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Affiliation(s)
- Raghav Nayar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Vaibhav Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Sunita Suman
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Subhash Soni
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Naveen Kumar
- Medical Gastroenterology, Mathura Das Mathur Hospital, Jodhpur, IND
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Joshi P, Yadav R, Dangi A, Kumar P, Kumar S, Gupta V, Gupta V, Chandra A. Corrosive Esophageal Strictures: From Dilatation to Replacement: A Retrospective Cohort Study. Dysphagia 2019; 35:558-567. [PMID: 31485830 DOI: 10.1007/s00455-019-10058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/21/2019] [Indexed: 01/21/2023]
Abstract
Endoscopic dilatation is the recommended primary therapy for chronic corrosive esophageal strictures (ES), and surgery is reserved for failed dilatation. Through this study, we intend to analyze the efficacy and long-term outcomes of both endoscopic and surgical interventions in corrosive ES. A retrospective cohort analysis of patients with chronic corrosive ES, managed with endoscopic or surgical procedures at a tertiary teaching institute in North India from December 2009 to December 2016, was performed from a prospectively maintained database. The primary outcome measure was the absence of dysphagia following dilatation or surgery. During the study period, 64 patients with ES underwent surgical or endoscopic treatment. Associated gastric strictures and pharyngeal strictures were present in 39 (60%) and 22 patients (28.9%), respectively. The mean age was 28.8 years and mean BMI was 14.2 kg/m2. Acid was the most common corrosive substance. Endoscopic dilatation using Savary-Gilliard (SG) dilators was successful in achieving persistent symptom relief in 46 patients (71.8%) after a total of 358 sessions (mean number of dilatations were 5.2 ± 1.2) of dilatations over 2 years. The dilatation therapy failed in 18 patients (28.1%) including technical failures (15.6%), perforations (3.1%), refractory stricture (1.5%) and recurrent strictures (7.8%). Increasing stricture length (more than 6 cm) was associated with poor outcome of endoscopic dilatation (p < 0.001). Only eleven patients (17%) required esophageal replacement (resection: 0, bypass: 11) for failed dilatations including seven gastric pull-ups and four pharyngo-coloplasty. The stricture rate after surgery was 36.3% (4/11). The median follows up was 32 months. Endoscopic dilatation of corrosive ES is safe and effective therapy and should be the first-line therapy for these patients and surgery should be considered only in patients who have unsuccessful outcome following dilatation therapy.
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Affiliation(s)
- Pradeep Joshi
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Rakesh Yadav
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Amit Dangi
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Pavan Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Saket Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Vivek Gupta
- Department of Human Organ Transplant, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Vishal Gupta
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
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Fujisawa D, Asato H, Tanaka K, Itokazu T, Kojya S. Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance: A case report. Arch Plast Surg 2019; 47:178-181. [PMID: 31018631 PMCID: PMC7093279 DOI: 10.5999/aps.2019.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.
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Affiliation(s)
- Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Tetsuo Itokazu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Shizuo Kojya
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
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Varshney VK, Nag HH, Vageesh BG. Laparoscopic and open transhiatal oesophagectomy for corrosive stricture of the oesophagus: An experience. J Minim Access Surg 2017; 14:23-26. [PMID: 28782741 PMCID: PMC5749193 DOI: 10.4103/jmas.jmas_201_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Oesophagectomy for corrosive stricture of the oesophagus (CSE) is rarely performed due to high risk of iatrogenic complications. The aims of this study were to review our experience of transhiatal oesophagectomy (THE) in patients with CSE as well as to compare results of open and laparoscopic methods. Materials and Methods: This is a retrospective analysis of prospectively maintained data of patients with CSE who underwent open transhiatal oesophagectomy (OTE) or laparoscopic-assisted transhiatal oesophagectomy (LATE) by a single surgical team from 2012 to 2016. All study patients had either failed endoscopic dilatation or had a long stricture which was not amenable to endoscopic dilatation. Results: Totally, 35 patients were included in the study, of which 19 (54.3%) were female. OTE was performed in 20 (57%) patients, and LATE was performed in 15 (43%) patients. Gastric and colonic conduits were used in 23 (65.7%) and 10 (34.3%) patients, respectively. Demographic and clinical parameters were comparable between LATE and OTE groups (P > 0.05). Median intra-operative blood loss, post-operative requirement of analgesic and hospital stay were lower in LATE group (P ≤ 0.05). There was no hospital mortality (30 days), but three patients (8.6%) died during a median follow-up of 36 months. Conclusion: THE is a safe procedure for patients with CSE, and LATE may be an alternative approach in selected patients.
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Affiliation(s)
- Vaibhav Kumar Varshney
- Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Hirdaya H Nag
- Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - B G Vageesh
- Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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15
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Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture. World J Surg 2017; 42:211-217. [DOI: 10.1007/s00268-017-4167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Abstract
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France.
| | - Luigi Bonavina
- University of Milan Medical School, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael D Kelly
- Acute Surgical Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Emile Sarfati
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
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Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, Simic A, Ansaloni L, Catena F, Fraga GP, Locatelli C, Chiara O, Kashuk J, Coccolini F, Macchitella Y, Mutignani M, Cutrone C, Poli MD, Valetti T, Asti E, Kelly M, Pesko P. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg 2015; 10:44. [PMID: 26413146 PMCID: PMC4583744 DOI: 10.1186/s13017-015-0039-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/15/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. PURPOSE OF THE STUDY The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. METHODS An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). RESULTS One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. CONCLUSIONS The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.
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Affiliation(s)
- Luigi Bonavina
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Mircea Chirica
- />Department of Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Ognjan Skrobic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Yoram Kluger
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Aleksander Simic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- />Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Gustavo P. Fraga
- />Department of Surgery, University of Campinas, Campinas, Brasil
| | - Carlo Locatelli
- />Institute of Toxicology, University of Pavia, Pavia, Italy
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem Rehovot, Israel
| | | | - Yuri Macchitella
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | | | - Cesare Cutrone
- />Department of Otolaryngology, Azienda Ospedaliera, Padova, Italy
| | - Marco Dei Poli
- />Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tino Valetti
- />Department of Anesthesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Asti
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Michael Kelly
- />Department of Surgery, Wagga Wagga Hospital, Wagga Wagga, Australia
| | - Predrag Pesko
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
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Ezemba N, Eze JC, Nwafor IA, Etukokwu KC, Orakwe OI. Colon interposition graft for corrosive esophageal stricture: midterm functional outcome. World J Surg 2015; 38:2352-7. [PMID: 24748346 DOI: 10.1007/s00268-014-2574-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Corrosive esophageal stricture is a major cause of morbidity among Nigerians. In most cases, this follows accidental or parasuicidal ingestion of caustic sodium hydroxide solution (NaOH) often used in the local production of soaps. Various treatment modalities have been advocated for the treatment of esophageal stricture. In this study, we review the results of our adopted technique in the past 10 years for pedicled colonic interposition. METHODS This is a retrospective study of 21 patients who underwent substernal isoperistaltic pedicled colonic interposition graft for management of corrosive esophageal stricture. The right colon was pulled up into the neck in all the patients without resecting the strictured esophagus. RESULTS Long segment strictures and multiple strictures were the main indications for the procedure. The mean duration of the procedure was 339.6 ± 71.1 min. The average intraoperative blood loss was 673.1 ± 398.1 mL. There were two (9.5 %) hospital mortalities. Graft infarction (9.5 %), cervical fistulae (19.0 %), and reflux neo-esophagitis (14.3 %) were the main non-fatal complications. In the mid-term, dysphagia was completely relieved in a little over 84 % (16/19) of patients, while one patient (4.8 %) still experienced reflux neo-esophagitis requiring treatment. There was no case of gross regurgitation or nocturnal aspiration in the mid-term. CONCLUSIONS Although the use of pedicled colonic interposition graft offers a good mid-term functional outcome with relief of dysphagia, early postoperative morbidity is high. Graft infarction is the single most important factor for poor functional outcome and every effort must be made to prevent its occurrence.
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Affiliation(s)
- Ndubueze Ezemba
- Division of Cardiothoracic Surgery, National Cardiothoracic Center, University of Nigeria Teaching Hospital, Ituku-Ozalla, PMB 01129, Enugu, 400001, Nigeria,
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Shahi AS, Behdad B, Esmaeili A, Moztarzadeh M, Peyvandi H. Esophageal stenting in caustic injuries: a modified technique to avoid laparotomy. Gen Thorac Cardiovasc Surg 2015; 63:406-12. [PMID: 25971235 DOI: 10.1007/s11748-015-0558-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/01/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the outcomes of a modified laparoscopic intraluminal stenting with the conventional laparatomic technique in patients with esophageal caustic injuries. METHODS A total of 103 patients with esophageal burns were included in this retrospective analysis. Patients were candidates for esophageal stenting to prevent future stenosis. According to patient preference, stenting was done with either the innovatory stent with the modified technique (52 patients) or the conventional method that required laparotomy (51 patients). The modified technique consists of placing an inflation balloon stent via laparoscopy. Overall mortality and complications after follow-up period (3 months) were compared between the two groups. RESULTS Two perioperative mortalities were seen, one in each group. Except one patient in the modified technique, all patients returned to normal intake after 3 months of follow-up. However, five patients of the modified group and three in the conventional group developed esophageal strictures (p > 0.05). Gastric outlet obstruction was observed in three patients of the modified group and one in the conventional group (p > 0.05). DeMeester scores showed that there was no gastro-esophageal reflux in both groups (p > 0.05). CONCLUSION Our results show that the modified technique can reach the efficacy of the conventional method without requiring laparotomy. Thus, far several studies have demonstrated the advantages of laparoscopy over laparotomy. Thus, and in line with the clinical guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons, we recommend using the presented modified technique in patients with caustic esophageal injuries.
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Affiliation(s)
- Ali Sina Shahi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Thoracoscopic esophagectomy in the prone position for corrosive stricture after esophageal perforation due to balloon dilatation. Esophagus 2014. [DOI: 10.1007/s10388-013-0401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Boukerrouche A. Isoperistaltic left colic graft interposition via a retrosternal approach for esophageal reconstruction in patients with a caustic stricture: mortality, morbidity, and functional results. Surg Today 2013; 44:827-33. [PMID: 24150095 DOI: 10.1007/s00595-013-0758-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/04/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE To report our results of treating esophageal caustic stricture with an isoperistaltic left colic graft interposed via a retrosternal route. METHODS We reviewed 70 patients who underwent substernal left colon interposition, performed retrosternally, for an esophageal caustic stricture, between January, 1999 and December, 2011. RESULTS The median operative time in this series was 3 h. A pharyngoplasty was performed in 10 patients (14.28 %), the thoracic inlet was found to be enlarged in 33 patients (47.1 %), and posterior cologastric anastomosis was performed in 58 patients (82.8 %). Two patients (2.8 %) died. Minor and major postoperative complications developed in 28 patients (40 %), including graft ischemia in 2 (2.8 %) and cervical anastomotic leakage in 14 (20 %). Five patients (7.14 %) developed a cervical anastomotic stricture. The functional results were satisfactory. CONCLUSION Retrosternal isoperistaltic left colic transplant interposition is an excellent long-term replacement for an esophageal caustic stricture. If performed by experienced surgeons, this procedure is effective for esophageal reconstruction.
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Affiliation(s)
- Abdelkader Boukerrouche
- Department of Digestive Surgery, Beni-Messous Hospital, University of Algiers, Algiers, Algeria,
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Isoperistaltic left colic graft interposition via a retrosternal approach for esophageal reconstruction in patients with a caustic stricture: mortality, morbidity, and functional results. Surg Today 2013. [DOI: org/10.1007/s00595-013-0758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: A comprehensive review. World J Gastroenterol 2013; 19:3918-3930. [PMID: 23840136 PMCID: PMC3703178 DOI: 10.3748/wjg.v19.i25.3918] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 02/07/2023] Open
Abstract
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
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Abstract
Patients with corrosive induced esophageal strictures have an increased risk of esophageal carcinoma. We present a case of a 61-year-old man who ingested sulfuric acid at the age of 3 years and then developed dysphagia at late follow-up. In 2010, he presented to the outpatient clinic with weight loss and worsening dysphagia to both solids and liquids. A barium swallow radiograph and endoscopy demonstrated a long stricture in the middle third of the esophagus. Ivor-Lewis esophagectomy was undertaken via an upper midline abdominal incision and a right thoracotomy, and pathologic examination of the resection specimen confirmed a well-differentiated esophageal squamous cell carcinoma. Twenty-two months postoperatively, he reports no dysphagia, and no tumor recurrence was evident during follow-up.
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Affiliation(s)
- Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China.
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Mas E, Breton A, Lachaux A. [Management of caustic esophagitis in children]. Arch Pediatr 2012; 19:1362-8. [PMID: 23141564 DOI: 10.1016/j.arcped.2012.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/30/2012] [Accepted: 09/23/2012] [Indexed: 01/29/2023]
Abstract
In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food.
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Affiliation(s)
- E Mas
- Unité de gastroentérologie, hépatologie, nutrition et diabétologie, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31300 Toulouse cedex 9, France.
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Sikorszki L, Kalmár K, Pavlovics G, Papp A, Sajjadi SG, Szabó M, Horváth ÖP. Resection or bypass in the treatment of corrosive oesophageal strictures? Malignant transformation as a late complication in both methods. Eur Surg 2012. [DOI: 10.1007/s10353-012-0156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Okonta KE, Tettey M, Abubakar U. In patients with corrosive oesophageal stricture for surgery, is oesophagectomy rather than bypass necessary to reduce the risk of oesophageal malignancy? Interact Cardiovasc Thorac Surg 2012; 15:713-5. [PMID: 22821650 DOI: 10.1093/icvts/ivs320] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was, 'is there an increased risk of cancer in a non-resected corrosive oesophageal stricture?' Altogether, 133 papers were found using the reported search; six papers were identified that provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these studies were tabulated. From the studies, 198 consecutive patients had corrosive oesophageal stricture resulting from corrosive oesophageal injury, 50 of whom (25.3%) developed oesophageal cancer. The interval between the burn and the diagnosis of scar carcinoma was 46.1 years and ranged between 25 and 58 years. The incidence of carcinoma of the oesophagus among patients from the study was significantly higher than that of the general population. In one review, seven (13%) of 54 consecutive patients treated by conservative means for caustic oesophageal stricture (COS) developed oesophageal cancer, leading to the conclusion that simultaneous resection of the oesophagus with reconstruction for such patients would provide a better probability of being completely cured of the disease. Furthermore, in patients with COS in need of operation who had a bypass procedure, it was pointed out that malignancy may develop even years after the bypass operation in the remaining part of the oesophagus and so total oesophagectomy was suggested instead of bypass. In another study, as many as 10 (31.3%) of 32 patients with corrosive oesophageal stricture developed cancer. That gave further credence to the arguments against conservative treatment or bypassing of corrosive oesophageal strictures. The risk of morbidity for intrathoracic oesophageal replacement in uncomplicated cases was 2.4%. There were basically two things that were agreed from the studies: that corrosive-induced carcinoma can occur with a reasonably high incidence if part or all of the oesophagus was left during reconstructive surgery; and that simultaneous resection of the oesophagus at the time of reconstruction in a patient with corrosive stricture offered a better outcome. The limitations of the present review were the lack of randomized controlled trials and no close follow-up.
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Affiliation(s)
- Kelechi E Okonta
- Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital, Ibadan, Nigeria.
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Laparoscopic retrosternal bypass for corrosive stricture of the esophagus. Surg Endosc 2012; 26:3344-9. [PMID: 22552862 DOI: 10.1007/s00464-012-2307-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 04/02/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Surgical management of corrosive stricture of the esophagus entails replacement of the scarred esophagus with a gastric or colonic conduit. This has traditionally been done using the conventional open surgical approach. We herein describe the first ever reported minimally invasive technique for performing retrosternal esophageal bypass using a stomach conduit. METHODS Patients with corrosive stricture involving the esophagus alone with a normal stomach were selected. The surgery was performed with the patient in supine position using four abdominal ports and a transverse skin crease neck incision. Steps included mobilization of the stomach and division of the gastroesophageal junction, creation of a retrosternal space, transposition of stomach into the neck (via retrosternal space), and a cervical esophagogastric anastomosis. RESULTS Four patients with corrosive stricture of the esophagus underwent this procedure. The average duration of surgery was 260 (240-300) min. All patients could be ambulated on the first postoperative day and were allowed oral liquids between the fifth and seventh day. At mean follow-up of 6.5 (3-9) months, all are euphagic to solid diet and have excellent cosmetic results. CONCLUSIONS Laparoscopic bypass for corrosive stricture of the esophagus using a gastric conduit is technically feasible. It results in early postoperative recovery, effective relief of dysphagia, and excellent cosmesis in these young patients.
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Lachaux A, Mas E, Breton A, Barange K, Heresbach D, Molard BR. Consensus en endoscopie digestive : prise en charge des œsophagites caustiques. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10190-011-0191-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Tettey M, Edwin F, Aniteye E, Tamatey M, Entsua-Mensah K, Ofosu-Appiah E, Frimpong-Boateng K. Colopharyngoplasty for intractable caustic pharyngoesophageal strictures in an indigenous African community--adverse impact of concomitant tracheostomy on outcome. Interact Cardiovasc Thorac Surg 2010; 12:213-7. [PMID: 21047823 DOI: 10.1510/icvts.2010.241836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES 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. METHOD 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. CONCLUSION 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.
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Affiliation(s)
- Mark Tettey
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Box KB 846 Korle Bu, Accra. Ghana.
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Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg 2010; 252:271-80. [PMID: 20622655 DOI: 10.1097/sla.0b013e3181e8fd40] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to report our experience in the management of late morbidity after colonic interposition for caustic injury and to assess the influence of coloplasty dysfunction on patient outcome. SUMMARY BACKGROUND DATA Reports on coloplasty dysfunction after colon interposition for corrosive esophageal injuries are scarce in the literature. Dysfunction of the colonic substitute might jeopardize an already fragile functional result, and appropriate management can improve outcome. METHODS Long-term follow-up (>6 months) was conducted in 223 patients (125 men; median age, 35 years) who underwent colonic interposition for caustic injuries between 1987 and 2006. Statistical tests were performed on this cohort to identify risk factors for late morbidity and functional outcome. During the same period, 28 patients who underwent colon interposition for caustic injury in another center were referred for treatment of coloplasty dysfunction. Data from these patients were used together with those of our patients to describe specific coloplasty-related complications and their management. RESULTS With a median follow-up of 5 years (range: 6 months-20 years), late complications were recorded in 125 (55%) of our patients (stenosis 36%, reflux 11%, redundancy 5%). A delay in reconstruction <6 months (P = 0.03) and absence of thoracic inlet enlargement (P = 0.002) were independent predictive factors for cervical anastomotic stenosis. Functional failure was recorded in 52 patients (23%) and was associated with a delay in reconstruction <6 months (P = 0.009) and emergency tracheotomy (P = 0.002). Coloplasty dysfunction was responsible for half of the recorded failures. Revision surgery for coloplasty dysfunction was performed in 96 patients (68 local, 28 referred) with an overall 70% success rate. CONCLUSIONS Late complications occurred in half of the patients after colonic interposition for corrosive injuries and accounted for half of the functional failures. Prolonged surgical follow-up and appropriate management of coloplasty dysfunction are key factors for long-term success after esophageal reconstruction for caustic injuries.
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Cheng YJ, Wang KH, Chen HC, Hsieh KC, Chang PC. Esophageal mucocele with compression of the right recurrent laryngeal nerve 20 years after surgical intervention for caustic esophagitis. Ann Thorac Surg 2010; 90:e28-9. [PMID: 20667308 DOI: 10.1016/j.athoracsur.2010.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 04/29/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
A 48-year-old woman presented with 3 days of hoarseness and 1 week of unrelenting back pain. Her medical history was remarkable for an esophageal operation 20 years before to repair damage from caustic esophagitis. The computed tomography scan identified a large esophageal mucocele. Resection of the remaining intrathoracic esophagus was required for complete resolution of the patient's symptoms.
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Affiliation(s)
- Yu-Jen Cheng
- Division of Thoracic Surgery, Department of Surgery, E-DA Hospital/I-Shou University, Kaohsiung County, Taiwan
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Melhado RE, Alderson D, Tucker O. The changing face of esophageal cancer. Cancers (Basel) 2010; 2:1379-404. [PMID: 24281163 PMCID: PMC3837312 DOI: 10.3390/cancers2031379] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 06/24/2010] [Accepted: 06/24/2010] [Indexed: 12/14/2022] Open
Abstract
The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.
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Affiliation(s)
- Rachel E Melhado
- Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK.
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Chirica M, de Chaisemartin C, Munoz-Bongrand N, Halimi B, Celerier M, Cattan P, Sarfati E. Reconstruction œsophagienne pour séquelles de brûlure caustique : coloplasties, mode d’emploi. ACTA ACUST UNITED AC 2009; 146:240-9. [DOI: 10.1016/j.jchir.2009.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Szabó M, Pavlovics G, Papp A, Horváth OP. [Development of scar cancer after subtotal oesophagectomy for corrosive injury]. Magy Seb 2009; 62:71-74. [PMID: 19386567 DOI: 10.1556/maseb.62.2009.2.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The incidence of cicatricial carcinoma of the scarred esophagus in patients with corrosive injuries is relatively high. Therefore, the necessity to resect the diseased oesophagus was raised as opposed to carry out a simple by-pass reconstruction only. CASE REPORT A 56-year-old female patient with a past medical history of lye consumption presented with a stricture of the esophagus. She underwent resection of the diseased esophagus with mediastinal colon interposition. 28 years after surgery the patient had symptoms of progressive dysphagia and loss of weight caused by scar cancer of the esophagus. After neoadjuvant chemo-radiotherapy, resection of the remainder oesophagus was performed with free jejunal transplantation. On postoperative day 14 the patient had been discharged with no complications and good swallowing function. CONCLUSION In our case, scar cancer developed 28 years after oesophageal resection and more than 50 years after the corrosive injury. This case is another argument for simple bypass.
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MESH Headings
- Adult
- Anastomosis, Surgical
- Burns, Chemical/complications
- Burns, Chemical/etiology
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/physiopathology
- Carcinoma, Squamous Cell/surgery
- Caustics/adverse effects
- Cell Transformation, Neoplastic
- Chemotherapy, Adjuvant
- Child, Preschool
- Cicatrix/pathology
- Cicatrix/surgery
- Colon/transplantation
- Deglutition
- Esophageal Neoplasms/etiology
- Esophageal Neoplasms/physiopathology
- Esophageal Neoplasms/surgery
- Esophageal Stenosis/etiology
- Esophageal Stenosis/pathology
- Esophageal Stenosis/physiopathology
- Esophageal Stenosis/surgery
- Esophagectomy
- Female
- Humans
- Jejunum/transplantation
- Middle Aged
- Neoadjuvant Therapy/methods
- Radiotherapy, Adjuvant
- Tomography, X-Ray Computed
- Transplantation, Autologous
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Affiliation(s)
- Melinda Szabó
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika, Pécs, Hungary.
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Matsuki A, Kanda T, Kosugi SI, Suzuki T, Hatakeyama K. Gastric tube interposition for corrosive esophagitis associated with pyloric stenosis. Surg Today 2009; 39:261-4. [PMID: 19280289 DOI: 10.1007/s00595-008-3834-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 05/28/2008] [Indexed: 11/26/2022]
Abstract
Corrosive esophagitis, caused by swallowing corrosive acid or alkali, results in cicatricial stricture of the esophagus. The stricture is often accompanied by pyloric stenosis because strong acids act synergistically with gastric juice. Resection of both the esophagus and stomach is usually necessary, and the colon or jejunum is used as an esophageal substitute. We describe how we successfully treated corrosive esophagitis associated with pyloric stenosis, by performing gastric tube interposition for the esophageal reconstruction. After resecting the injured distal part of the stomach, we pulled the pedunculated gastric tube up to the cervix after anastomosis to the jejunal limb in a Roux-en-Y fashion. This reconstruction procedure prevented excessive organ sacrifice and was minimally invasive. Thus, esophageal reconstruction by interposition using a pedunculated gastric tube can be used effectively to treat corrosive esophagitis associated with pyloric stenosis.
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Affiliation(s)
- Atsushi Matsuki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata, 951-8510, Japan
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40
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Abstract
INTRODUCTION The usual indications for oesophageal replacement in childhood are intractable corrosive strictures and long-gap oesophageal atresia. Generally, paediatric surgeons attempt to preserve the native oesophagus with repeat dilatations. However, when this is not successful, an appropriate conduit must be fashioned to replace the oesophagus. The neo-oesophagus should allow normal oral feeding, not have gastro-oesophageal reflux, and be able to function well for the life-time of the patient. PATIENTS AND METHODS A Medline search for oesophageal replacement, oesophageal atresia, gastric transposition, colon transposition, gastric tube, caustic stricture was conducted. The commonest conduits including whole stomach, gastric tube, colon and jejunum are all discussed. RESULTS No randomised controlled studies exist comparing the different types of conduits available for children. The techniques used tend to be based on personal preference and local experience rather than on any discernible objective data. The biggest series with long-term outcome are reported for gastric transposition and colon replacement. Comparison of a number of studies shows no significant difference in early or late complications. Early operative complications include graft necrosis, anastomotic leaks and sepsis. Late problems include strictures, poor feeding, gastro-oesophageal reflux, tortuosity of the graft and the development of Barrett's oesophagus. The biggest series, however, seem to have lower complications than small series probably reflecting the experience, built up over years, in their respective centres. CONCLUSIONS Long-term follow-up is recommended because of the risks of late strictures, excessive tortuosity of the neo-oesophagus and the development of Barrett's oesophagus.
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Affiliation(s)
- G S Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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41
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Esophageal Squamous Cell Carcinoma of the Esophagocolonic Anastomosis after Subtotal Resection due to Caustic Burns. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-007-0131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Knezević JD, Radovanović NS, Simić AP, Kotarac MM, Skrobić OM, Konstantinović VD, Pesko PM. Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience. Dis Esophagus 2007; 20:530-4. [PMID: 17958730 DOI: 10.1111/j.1442-2050.2007.00694.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this article was to analyze 40 years of experience of colon interposition in the surgical treatment of caustic esophageal strictures from the standpoints of our long-term personal experience. Colon interposition has proved to be the most suitable type of reconstruction for esophageal corrosive strictures. The choice of colon graft is based on the pattern of blood supply, while the type of anastomosis is determined by the stricture level and the part of colon used for reconstruction. In the period between 1964 and 2004, colon interposition was performed in 336 patients with a corrosively scared esophagus, using the left colon in 76.78% of the patients. In 87.5% a colon interposition was performed, while in the remaining patients an additional esophagectomy with colon interposition had to be done. Hypopharyngeal strictures were present in 24.10% of the patients. Long-term follow-up results were obtained in the period between 1 to up to 30 years. Early postoperative complications occurred in 26.48% of patients, among which anastomosic leakage was the most common. The operative mortality rate was 4.16% and late postoperative complications were present in 13.99% of the patients. A long-term follow up obtained in 84.82% of the patients found excellent functional results in 75.89% of them. We conclude that a colon graft is an excellent esophageal substitute for patients with esophageal corrosive strictures, and when used by experienced surgical teams it provides a low rate of postoperative morbidity and mortality, and long-term good and functional quality of life.
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Affiliation(s)
- J D Knezević
- Department of Esophagogastric Surgery, First Surgical University Hospital, Clinical Center of Serbia, Belgrade, Serbia
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43
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Shalaby R, Shams A, Soliman SM, Samaha A, Ibrahim HA. Laparoscopically assisted transhiatal esophagectomy with esophagogastroplasty for post-corrosive esophageal stricture treatment in children. Pediatr Surg Int 2007; 23:545-9. [PMID: 17347839 DOI: 10.1007/s00383-007-1888-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2007] [Indexed: 12/01/2022]
Abstract
A tight post-corrosive esophageal stricture in a child poses significant surgical challenges. Many studies have described minimally invasive esophagectomy in adults, but very few reports have described this technique in children. Minimally invasive esophagectomy represents a new alternative to conventional open esophagectomy. This retrospective study evaluated the safety and efficacy of laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment. Twenty-seven children with post-corrosive esophageal stricture were subjected to this technique. Their ages ranged from 3 to 13.5 years (mean 5.6 years). Fourteen were females and thirteen were males. None of the procedures needed to be converted to an open approach, and there were neither intra-operative complications nor increased blood loss. Left-sided pneumothorax occurred in one case only (3.7%). The mean operating time was 160 min (range 120-180). Three patients were admitted postoperatively to intensive care unit for a period of 48 h for assisted ventilation. Mean hospital stay was 4 days (range 3-7 days). Anastomotic leakage occurred in three patients (11.1%), while anastomotic stricture occurred in four patients (14.8%). About 93.5% of our cases have achieved excellent results. Post-operative nutritional status was satisfactory and accepted. Laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment in children is safe, visible, effective, and an accepted operative technique. The cosmetic result is excellent.
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Affiliation(s)
- Rafik Shalaby
- Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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BURMEISTER BH, WALPOLE ET, THOMAS J, SMITHERS BM. Two cases of esophageal carcinoma following corrosive esophagitis successfully treated with chemoradiation therapy. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2007.00096.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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45
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Jiang YG, Lin YD, Wang RW, Zhou JH, Gong TQ, Ma Z, Zhao YP, Tan QY. Pharyngocolonic anastomosis for esophageal reconstruction in corrosive esophageal stricture. Ann Thorac Surg 2006; 79:1890-4. [PMID: 15919279 DOI: 10.1016/j.athoracsur.2004.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Revised: 12/15/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of our study is to observe the outcome of pharyngocolonic anastomosis in esophageal reconstruction for diffuse corrosive esophageal stricture involving hypopharynx. METHODS This is a retrospective report of the experience and results of 14 patients undergoing esophageal reconstruction with pharyngocolonic anastomosis without resection of the strictured intrathoracic esophagus. The left colonic segment was pulled up to the neck through the substernal space in all patients. RESULTS There was no operative or hospital death. Postoperative complications included cervical anastomotic leakage in 4 patients, rupture of abdominal incision in 1 patient, and aspiration pneumonia in 2 patients. The length of follow-up ranged from half a year to 10 years, with an average of 4 years. Anastomotic stenosis occurred in 2 patients. One patient was improved after dilatation and the other was relieved by plastic operation. One patient began to have vomiting after meals 7 months after surgery and was found to have redundant abdominal colon graft, which was corrected with a side-to-side anastomosis between the colon and the stomach. CONCLUSIONS A successful reconstruction for hypopharyngoesophageal stricture requires a sufficiently large hypopharyngocolonic anastomosis and a technique of good anastomosis. From our experience, this procedure is shown to be safe and effective.
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Affiliation(s)
- Yao-Guang Jiang
- Thoracic Surgery Department, Daping Hospital, Chongqing, China.
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46
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Kaya M, Boleken ME, Memetoglu E, Celik H, Kanmaz T, Kocyigit A, Yucesan S. Evaluation of systemic oxidative status and mononuclear leukocytes DNA damage in children with caustic esophageal stricture. Dis Esophagus 2006; 19:280-4. [PMID: 16866861 DOI: 10.1111/j.1442-2050.2006.00579.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal stricture (ES) due to accidentally caustic digestions is a common problem in children. Mucosal damage and repeated dilatations lead to chronic inflammation and finally ES. We investigated the oxidative status and DNA damage of children with ES. Five children with ES were compared with the same age- and sex-matched healthy subjects. Oxidative status of plasma was evaluated by measuring myeloperoxidase (MPO) activity, and total peroxide (TP) level. Anti-oxidative status of the plasma was evaluated by measuring catalase (CAT) activity, and total antioxidant response (TAR). We used the Single Cell Gel Electrophoresis (also called Comet Assay) to measure DNA strand break in peripheral blood mononuclear leukocytes. Mean MPO activity and TP levels in the ES group were significantly higher than the control group (0.83 +/- 0.35, 0.09 +/- 0.03 and 0.98 +/- 0.38, 0.34 +/- 0.20, P = 0.009 and P = 0.047 respectively). There was no significant difference in CAT activity and TAR levels between the two groups (P = 0.347). DNA damage in patients with ES was increased compared to control subjects (108.8 +/- 51.2 and 57.6 +/- 31.2 arbitrary units, respectively), but this difference was not significant statistically (P= 0.09). This study shows that systemic oxidative stress and alteration at the nuclear level occur in patients with ES, as a result of multiple dilatations and tissue injury. On the other hand, these results support that patients with ES may benefit from antioxidant treatment.
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Affiliation(s)
- M Kaya
- Department of Pediatric Surgery, Medical Faculty, Harran University, Sanliurfa, Turkey.
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47
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Zhou JH, Jiang YG, Wang RW, Lin YD, Gong TQ, Zhao YP, Ma Z, Tan QY. Management of corrosive esophageal burns in 149 cases. J Thorac Cardiovasc Surg 2005; 130:449-55. [PMID: 16077412 DOI: 10.1016/j.jtcvs.2005.02.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to present our experience in the management of esophageal burns. METHODS From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy. RESULTS Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets. CONCLUSIONS Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.
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Affiliation(s)
- Jing-Hai Zhou
- Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
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Han Y, Cheng QS, Li XF, Wang XP. Surgical management of esophageal strictures after caustic burns: A 30 years of experience. World J Gastroenterol 2004; 10:2846-9. [PMID: 15334683 PMCID: PMC4572115 DOI: 10.3748/wjg.v10.i19.2846] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To analyze a 30-year historical series of patients treated in our hospital, who ingested corrosive substances, and to assess the effectiveness of surgical therapy administered in patients with strictures after caustic injury in esophagus during this period.
METHODS: A total of 79 cases of caustic burns in esophagus were treated in Tangdu Hospital from 1971 to 2001. Their clinical and pathological data were reviewed, and collected from the medical records of patients and interviews with them.
RESULTS: More men (n = 61) than women (n = 18) ingested caustic substances with a sex ratio of 3.4:1 during the 30-year period. The caustic materials were liquid lye and acids (54 cases and 25 cases, respectively). Sixty-eight patients were given esophageal replacement in more than three months after caustic injury with no postoperative death, of which 17 cases developed postoperative complications making a complication rate of 25%. The most common one was cervical anastomotic leakage. All patients had improvement in swallowing afterwards.
CONCLUSION: The presence and severity of injuries are correlated with the amount of caustic substances ingested. Surgical treatment is a good option in patients with severe strictures, and colonic interposition might be the best surgical process. The most important factors to guarantee a successful outcome for surgery are good vascular supply and absence of tension in the anastomosis.
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Affiliation(s)
- Yong Han
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
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Abstract
Esophageal stricture after lye ingestion in children is the most frequent indication for esophagectomy in children, but this operation entails significant risks for complications. With continuing advances in minimally invasive technology, complex procedures such as esophagectomy can be performed using small incisions, with the aim of reducing morbidity and mortality. Experience with minimally invasive esophagectomy is limited and has involved thoracoscopic dissection with the addition of laparotomy for gastric mobilization. The authors report a case of intractable caustic esophageal stricture in a child treated by a totally minimally invasive esophagectomy through a combined thoracoscopic and laparoscopic approach. In adult patients, this procedure has been associated with decreased hospital stay and more rapid return to normal activities, and we believe similar benefits will be obtained in children. Until further studies are done to show the advantage over the standard open technique, this procedure should be performed only in centers with experience in open esophageal surgery in children as well as by surgeons with advanced thoracoscopic and laparoscopic skills.
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Affiliation(s)
- Benedict C Nwomeh
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15213, USA
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50
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Abstract
OBJECTIVES To analyze the feasibility and safety of transhiatal approach for resection of corrosively scarred esophagus. BACKGROUND SUMMARY DATA: The unrelenting corrosive strictures of esophagus merit esophageal substitution. Because of the risk of complications in the retained esophagus, such as malignancy, mucocele, gastroesophageal reflux, and bleeding, esophageal resection is deemed necessary. Transthoracic approach for esophageal resection is considered safe. The safety and feasibility of transhiatal resection of the esophagus is not established in corrosive injury of the esophagus. PATIENTS AND METHODS Transhiatal approach was used for resection of the scarred esophagus for all patients between January 1986 and December 2001. The intraoperative complications, indications for adding thoracotomy, and postoperative outcome were studied in 51 patients. Follow-up period varied from minimum of 6 months to 15 years. RESULTS Esophageal resection was achieved in 49 of 51 patients whereas thoracotomy was added in 2 patients. In 1 of the patients tracheal injury occurred whereas in other patient there were dense adhesions between tracheal membrane and esophagus. Gastric tube was used for esophageal substitution in 40 (78.4%) patients whereas colon was transplanted in 11 (21.6%) patients. Colon was used only when stomach was not available. One patient (1.9%) had tracheal membrane injury whereas 4 patients (7.8%) had recurrent laryngeal nerve palsy. One patient each had thoracic duct injury and intrathoracic gastric tube leak. There was no operative mortality. Anastomotic complications like leak were present in 19.6% and stricture in 58.8% patients. All the patients were able to resume their normal duties and swallow normal food within 6 months of the surgery. CONCLUSION One-stage transhiatal esophageal resection and reconstruction could be safely used for the extirpation of scarred esophagus. Use of gastric conduit was technically simple, quicker, and offered good functional outcome. Postoperative anastomotic stricture amenable to dilatations was the commonest complication.
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Affiliation(s)
- Narendar Mohan Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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