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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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Sharma P, Pancholi M. Two-Point Fixation Technique in Retrosternal Midcolon Interposition for Corrosive Stricture of Esophagus-Our Experience With 25 Patients. Surg Innov 2020; 27:675-682. [PMID: 32909909 DOI: 10.1177/1553350620958568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In 1911, Vuillet and Kelling independently described the anatomical and surgical bases of esophageal replacement with the colon. An important complication, in particular in later follow-up, is redundancy of the interposed colon, seen more after retrosternal interposition. The best treatment is prevention by a meticulous surgical technique and measurement of the length of the colon needed to replace the esophagus. Methods. This was a retrospective study of innovative surgical technique. A total of 25 patients with corrosive stricture of the esophagus undergoing two-point fixation in retrosternal colon interposition were included in the study. Preventive Operative Technique. After straightening of conduit by pulling very delicately over both sides, first fixation point we considered cervical anastomoses and second fixation point was made in subxiphoid space, taking two seromuscular stiches from the antimesenteric border of the colon to falciform ligament situated on the right side of the conduit. Results. There were 07 male and 18 female patients with M:F was 1:2.5; mean age was 29 years (range: 23-45 years) and mean hospital stay was 14 days (range: 10-23 days). In this study, we did not encounter any subjective or objective evidence of redundancy in any patients in follow-up barium swallow after 2.5 years of follow-up. Conclusion. Our Two-point fixation technique is refinement of already performed and tried fixation techniques to prevent redundancy of the colon conduit considering kinetics, anatomical alignment, and pathology.
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Affiliation(s)
- Praveen Sharma
- Department of Surgery, Government Medical College, India
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Kohli PS, Mangal H, Neduvanchery S, Penumadu P. Carcinoma in a Colonic Conduit Post Esophagectomy: a Case Report. Indian J Surg Oncol 2019; 10:406-409. [PMID: 31168274 DOI: 10.1007/s13193-019-00903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022] Open
Abstract
Colon Conduit is a commonly used form of reconstruction post esophagectomy either for malignancy, strictures due to caustic acid ingestion, or other benign conditions. Carcinoma of the Colon Conduit following esophagectomy is a complication with an extremely low incidence and the management options are not clear. Thorough search of literature showed only 16 such cases. Hence, we report a case of a patient who underwent colon conduit reconstruction for a gastroesophageal (GE) junction tumor and developed a recurrence 4 years after the initial surgery.
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Ong J, Swift C, Al-Naeeb Y. Dysphagia: Multiple Pathologies, One Cause. Gastroenterology 2018; 154:e13-e14. [PMID: 28865729 DOI: 10.1053/j.gastro.2017.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/24/2017] [Indexed: 12/02/2022]
Affiliation(s)
- John Ong
- Department of Gastroenterology, Bedford Hospital NHS Trust, Huntingdon, United Kingdom
| | - Carla Swift
- Department of Gastroenterology, Hinchingbrooke Hospital NHS Trust, Huntingdon, United Kingdom
| | - Yasseen Al-Naeeb
- Department of Gastroenterology, Bedford Hospital NHS Trust, Huntingdon, United Kingdom
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Danardono E. Case Report: POST ESOPHAGECTOMY ESOPHAGEAL RECONSTRUCTION IN ESOPHAGEAL INJURY DUE TO CAUSTIC MATERIALS. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v53i4.7163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The esophageal caustic injury is rare, but it requires precise and complex management. A variety of reconstruction techniques have been done, but despite the increasing volume, the incidence of complications is still relatively high. We reported the experience in our center in handling esophageal reconstruction in patients with caustic esophageal injury that caused oesophageal stricture between 2014-2017. This study used case series method with literature review. The results showed that between 2014-2017, there were 3 patients with caustic esophageal injury. All patients undergoing esophageal reconstruction surgery were included under conditions of malnutrition. Two were caused by HCl and the rest by NaOH. All patients underwent a resection of stricture segment of the esophagus, either using partial or total esophagectomy. Anastomosis leakage occurred in all cases, but improved with conservative treatment. The average length of hospitalization was 27 days. The intraoperative blood loss in patients ranged from 450-700 cc. In conclusion, proper preliminary management can provide approppiate preparation of the patients for definitive or reconstructive surgery, especially to avoid malnutrition. The ideal reconstruction still could not be established, and the rate of postoperative complications was still high. The length of patient hospitalization was also relatively long.
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Handaya Y, Sunardi M. Ileocolonic Transposition Esophagogastric Bypass as an Antireflux Treatment for Corrosive Esophageal Injury. Ann Coloproctol 2017; 33:150-155. [PMID: 28932725 PMCID: PMC5603345 DOI: 10.3393/ac.2017.33.4.150] [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] [Received: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022] Open
Abstract
Because most surgeons perform an esophagectomy and colonic transposition as the main reconstruction method for patients with esophageal stenosis caused by swallowing corrosive materials, we report 2 cases in which ileocolonic transposition was used to treat such patients. Both patients displayed stenosis in the middle third of the esophagus. Their chief complaint was dysphagia. Ileocolonic transposition using vascularization of the Drummond and ileal arteries was followed by a prepared ileocolic graft by ligating ileocolic vessels. We performed an ileocolonic transposition esophagogastric bypass without an esophagectomy. All surgeries resulted in minimal intraoperative bleeding. Patients experienced no leakage, postoperative fistulas, dysphagia, or postoperative reflux. Three weeks after surgery, 1 patient experienced reversible hoarseness caused by extensive laryngeal-nerve manipulation. Cumulatively, ileocolonic transposition with cervical anastomosis for the treatment of patients with esophageal stenosis caused by corrosive esophageal injury can be considered to be an antireflux treatment because the ileocaecal sphincter is maintained.
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Affiliation(s)
- Yuda Handaya
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mukhamad Sunardi
- Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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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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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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Fisher RA, Griffiths EA, Evison F, Mason RC, Zylstra J, Davies AR, Alderson D, Gossage JA. A national audit of colonic interposition for esophageal replacement. Dis Esophagus 2017; 30:1-10. [PMID: 28375436 DOI: 10.1093/dote/dow003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/12/2016] [Indexed: 12/11/2022]
Abstract
Esophageal replacement by colonic interposition is an uncommon procedure. This study sought to identify the frequency of this operation in England, identify techniques and associated problems, and also assess health-related quality of life (HR QOL) from the two largest centers performing this procedure. Hospital Episode Statistics were used to identify patients and centers undertaking colon interposition between March 2001 and March 2015. An online survey of UK consultants discussed methods and experience. HR QOL was assessed using the Short Form 36(SF-36v2) with additional gastrointestinal questions. Hospital Episode Statistics identified 328 interpositions (22 in pediatric hospitals). The two highest volume units did 42 and 45 operations, respectively. Thirty-four surgeons (79% response rate) replied to the survey. Fifty-two percent preferred to use the left colon with 81% preferring a substernal placement. The HR QOL survey was performed on 24 patients with a median of 3 years after surgery (ranging from 9 months to 10 years) from the two largest centers and a 56% response rate. Five patients had physical QOL scores above population average and 10 had mental scores above population average. All patients had early satiety, 20 described dysphagia, and 18 regularly took antireflux medication. There was an estimated mean loss of 13.1% body weight (10.6 kg) postoperatively and three patients still relied on a feeding tube for nutrition after an average of 3 years. Colon interposition results in an acceptable long-term QOL. Few centers regularly perform this operation, and centralizing to high-volume centers may lead to better outcomes.
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Affiliation(s)
- R A Fisher
- GKT School of Medical Education, King's College London, London, UK.,Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - F Evison
- Department of Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R C Mason
- GKT School of Medical Education, King's College London, London, UK.,Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Zylstra
- GKT School of Medical Education, King's College London, London, UK.,Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A R Davies
- GKT School of Medical Education, King's College London, London, UK.,Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Alderson
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J A Gossage
- GKT School of Medical Education, King's College London, London, UK.,Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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The cervicosternolaparotomy approach for the treatment of graft dysfunction after retrosternal esophageal reconstruction for caustic injuries. J Thorac Cardiovasc Surg 2016; 152:1378-1385. [PMID: 27650003 DOI: 10.1016/j.jtcvs.2016.07.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/19/2016] [Accepted: 07/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries. METHODS Patients who underwent cervicosternolaparotomy during revision surgery for graft dysfunction between 1999 and 2015 were included. Cervicosternolaparotomy was performed to mobilize and pull up the primary conduit during surgery for strictures (rescue cervicosternolaparotomy) or to allow retrosternal access for management of other graft-related complications (exposure cervicosternolaparotomy). Statistical tests were performed to identify factors associated with primary conduit preservation during rescue cervicosternolaparotomy. RESULTS Fifty-five patients were included (28 men; median age, 43 years). Median delay between primary reconstruction and cervicosternolaparotomy was 15 months. Exposure cervicosternolaparotomy was performed in 12 patients (22%) for redundancy (n = 8), spontaneous perforation (n = 2), and caustic reingestion (n = 2). Rescue cervicosternolaparotomy was performed in 43 patients (78%) to treat supra-anastomotic (n = 11), anastomotic (n = 23), and diffuse (n = 9) stenosis. During rescue cervicosternolaparotomy, the primary conduit was preserved in 32 patients; median length gain obtained by transplant release was 8 cm. Failure to preserve the primary conduit was associated with previous surgical repair attempts (P = .003) and lack of initial concomitant pharyngeal reconstruction (P = .039). Two patients died (4%), and 35 patients (64%) experienced operative complications. Operative outcomes were similar after rescue and exposure cervicosternolaparotomy. With a median follow-up of 4.4 years, the functional success rate was 85%. CONCLUSIONS Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.
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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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Ishchuk T, Raetska Y, Savchuk O, Ostapchenko L. Changes in blood protein composition under experimental chemical burns of esophageal development in rats. BIOMEDICAL RESEARCH AND THERAPY 2015. [DOI: 10.7603/s40730-015-0009-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kumar NAN, Ramalingam R, Kumar HH, Ramkumar A, Vijayahari R. Ileocolon Interposition Graft Following Surgery for Gastro-esophageal Junction Adenocarcinoma. Indian J Surg Oncol 2014; 4:151-4. [PMID: 24426718 DOI: 10.1007/s13193-013-0227-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/05/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Naveena A N Kumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Rajeshwaran Ramalingam
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Harish H Kumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Aravind Ramkumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Ranjit Vijayahari
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Harlak A, Yigit T, Coskun K, Ozer T, Mentes O, Gülec B, Kozak O. Surgical treatment of caustic esophageal strictures in adults. Int J Surg 2012; 11:164-8. [PMID: 23267851 DOI: 10.1016/j.ijsu.2012.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/28/2012] [Accepted: 12/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Caustic esophageal injury is a rare clinical condition in adult patients. Although dilatation, or the conservative approach, is the primary treatment method, some patients require surgical intervention. Because of the rarity of such cases, standard surgical treatment algorithms cannot be utilized. In this article, we present our surgical experience and discuss the challenges in the surgical management of corrosive injury of the esophagus in adults. METHODS A retrospective review was conducted of 28 patients who suffered from a corrosive esophageal injury between 1996 and 2011. Patient demographics, history of corrosive material ingestion, preoperative findings, treatment strategy, operative technique, postoperative course, requirements for further treatment, and the current status of the patients were investigated. RESULTS All patients underwent a transhiatal esophagectomy in addition to a gastric pull-up with a cervical esophagogastrostomy. The mean follow-up time was 62 (12-140) months. One patient developed a deep surgical infection; anastomotic stenosis was noted and treated with dilatation in 13 patients. The mean time period between the operation and the first dilatation for 12 patients was 81 (45-161) days. The mean dilatation count for the patients was 3 (1-10). CONCLUSION Although it comes with high anastomotic stenosis rates, transhiatal esophagectomy and gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of corrosive esophageal stricture.
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Affiliation(s)
- Ali Harlak
- Gülhane Military Medical Academy, Gulhane Medical School, Department of General Surgery, GATA Genel Cerrahi AD., Etlik, Ankara 06018, Turkey.
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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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