Physiologic Type Reconstruction in Complicated Corrosive Strictures of Upper Gastrointestinal Segment

L. Kotsis^1*, Z. Krisár², P. Vadász¹

¹Thoracic Surgical Department of National Korányi Tbc and Pulmonology Institute, Budapest, Hungary.
²Department of Surgery, Hospital Oradea, Romina.

DOI: 10.4236/ss.2015.64029                

Abstract

Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures a limited Billroth I resection (in 9) or conversion a prior precolic GEA in such anastomosis (in 5) and middle or total gastrectomies (in 3) were performed. A second stage substernal by-pass with isoperistaltic transverse colon segment was done 6 - 12 weeks later. In all but one instances the graft was implanted high in the gastric stump. In extensive burned and retracted such lesion (in 3) a similar by-pass was carried out but the lower anastomosis was done with the not involved prepyloric segement. In concomittant antropyloric and esophageal strictures in 11 young, good risk patients, a limited Billroth I resction and simultaneous colonic bypass was used. In case of accompanied respiratory fistula (in 4) exclusion by-pass was useful for both lesions. The associated pyloric stricture (in 3) was solved at the same time. Side-to-end pharyngocolostomy was used in 4 high thoracocervical strictures. In 8 previously perforated strictures the by-ass was performed 2 months later. Reults: The overall mortality was 4%. The postoperative morbidity was low (8%). All cervical leaks closed spontaneously. Particular late complications required revisional surgery in 12, 5% of cases. Conclusion: In complicated corrosive strictures (esophageal, gastric, fistulas) limited Billoth I resection, isoperistaltic colon by-pass with high gastrocolic anastomosis, good gastric drainage and maintenance of the duodenum in gastrointestinal continuity are the main factors to achieve the best functional results.

Keywords

Complicated Corrosive Strictures, Gastric, Esophageal, Fistulas, Limited Billroth I Resection, Isoperistaltic Colonic By-Pass, Anastomosis with the Gastric stump

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dubost, C.I. (1976) Les grands brulures caustiques oeso-gastriques de l’adulte. Journal the Chirurgie, 112, 385-408.
[2]	Chien, K.Y., Wang, P.Y. and Lu, K.S. (1974) Esophagoplasty for Corrosive Stricture of the Oesophagus: An Analysis of 60 Cases. Annals of Surgery, 174, 510-515.
[3]	Noircler, M., Dicostanzo, J., Sastre, B., Durif, L., Fulachier, V. and Botta, D. (1984) Reconstructive Operations for Esophagogastric Corrosive Lesions. Journal of Thoracic and Cardiovascular Surgery, 97, 291-294.
[4]	Wu, M.H., Tseng, Y.T., Lin, M.Y. and Lai, W.-W. (2001) Esophageal Reconstruction for Hypopharyngoesophageal Strictures after Corrosive injury. European Journal Cardio-Thoracic Surgery, 19, 400-405. http://dx.doi.org/10.1016/S1010-7940(01)00614-5
[5]	Montenegro, E.B. and Cutait, D.E. (1958) Construction of a New Esophagus by Means of the Transverse Colon and Its Application for Caustic Atresia, Carcinoma and Varices of the Esophagus. Surgery, 44, 758-794.
[6]	Petrov, B.A. (1964) Retrosternal Artificial Esophagus Created from Colon: 100 Operations. Surgery, 55, 520-523.
[7]	Belsey, R. (1983) Reconstruction of the Esophagus. Ann R Coll Surg Engl, 65, 360-364.
[8]	Wilkins, E.W. (1980) Long-Segment Colon Substitution for the Esophagus. Annals of Surgery, 192, 722-725. http://dx.doi.org/10.1097/00000658-198012000-00005
[9]	DeMeester, T.R., Johnson, K.E., Franse, I., et al. (1988) Indications, Surgical Technique and Long Ter Functional Results of Colon Interposition or Bypass. Annals of Surgery, 208, 460-474. http://dx.doi.org/10.1097/00000658-198810000-00008
[10]	Gerzic, Z.B., Knezevic, J.B., Milicevic, M.N. and Jovanovic, B.K. (1999) Esophagoplasty in the Management of Postcorrosive Strictures of Esophagus. Annals of Surgery, 211, 329-336. http://dx.doi.org/10.1097/00000658-199003000-00004
[11]	Kotsis, L., Krisár, Z., Orbán, K. and Csekeo, A. (2002) Late Complications of Coloesophagoplasty and Long-Term Features of Adaptation. European Journal of Cardio-Thoracic Surgery, 21, 79-83.
[12]	Han, Y., Cheng, Q.S., Li, X.F. and Wang, X.P. (2004) Surgical Management of Esophageal Strictures after Caustic Burns: A 30 Years of Experience. World Journal of Gastroenterology, 10, 2846-2849.
[13]	Kotsis, L., Krisár, Z. and Dobjanschy, A. (1972) Angiological Basis of Coloesophagoplsty. Digest Surg, 1, 63-65.
[14]	Gupta, S. (1996) Surgical Management of Corrosive Strictures Following Acid Burnes of Upper Gastrointestinal Tract. European Journal of Cardio-Thoracic Surgery, 10, 934-940. http://dx.doi.org/10.1016/S1010-7940(96)80393-9
[15]	Sonneland, J., Anson, B.J. and Beaton, L.E. (1958) Surgical Anatomy of the Arterial Supply to the Colon from the Superior Mesenteric Artery Based upon a Study of 600 Specimens. Surgery, Gynecology & Obstetrics, 106, 385-398.
[16]	Nardi, G. (1957) Surgical Treatment of Lye Strictures of the Esophagus by Mediastinal Colon Transplant without Resection. New England Journal of Medicine, 75, 141-147.
[17]	Imre, J. and Kopp, M. (1972) Arguments against Long Term Conservative Treatment of Esophageal Strictures Due to Corrosive Burns. Thorax, 27, 594-598. http://dx.doi.org/10.1136/thx.27.5.594
[18]	Kotsis, L., Kulka, F. and Krisár, Z. (1988) Quelles sont les indications d’une chirurgie conservatrice dans les sténoses caustiques? Lésions benignes de l’ oesophag et canser. Springer-Verlag, Giuli, 770-773.
[19]	Postlethwait, R.W. (1983) Colonic Interposition for Esophageal Substitution. Surgery, Gynecology & Obstetrics, 156, 377-383.
[20]	Isolauri, J. (1987) Colon Interposition in Esophagus. Thesis, Tampere Finnland.