TITLE:
Physiologic Type Reconstruction in Complicated Corrosive Strictures of Upper Gastrointestinal Segment
AUTHORS:
L. Kotsis, Z. Krisár, P. Vadász
KEYWORDS:
Complicated Corrosive Strictures, Gastric, Esophageal, Fistulas, Limited Billroth I Resection, Isoperistaltic Colonic By-Pass, Anastomosis with the Gastric stump
JOURNAL NAME:
Surgical Science,
Vol.6 No.4,
April
24,
2015
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.