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European Journal of Cardio-Thoracic Surgery, Vol 10, 934-940, Copyright © 1996 by European Association for Cardio-thoracic Surgery

ARTICLES

Surgical management of corrosive strictures following acid burns of upper gastrointestinal tract

S Gupta
Calcutta National Medical Centre, India.

OBJECTIVE: Acid burns of the upper gastrointestinal tract produce a complex combination of lesions which can be grouped into five types, and existing surgical techniques have proved inadequate in treating some of these lesions. METHODS: Over the past 25 years 72 patients have needed operative treatment since they could not be managed by more conservative measures; the anatomical lesions in the five types and their surgical management are described. RESULTS: There were two early and one late death and morbidity was low in the long-term follow-up examinations, which included gastric secretory functions, transit time estimation with gamma camera and contrast radiography. CONCLUSIONS: The conclusions are 1) a variable approach is needed for each individual patient, 2) the right colon has proved suitable for esophageal bypass, 3) the ileum is included, when necessary, by making a side-to-side ileocaecoplasty to make it into a straight conduit and eliminate the caecal bulk and ileocaecal valve, 3) augmentation gastroduodenoplasty using a split jejunum or colon is very satisfactory for reconstructing a burnt contracted stomach, 4) posterior colopharyngeal anastomosis, performed as a pharyngoplasty by excising or widely incising the fibrosed posterior wall of the pharynx, restores normal deglutition, 5) parenteral vitamin B12 replacement is necessary in severe gastric burns.

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