The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 291-294, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Reconstructive operations for esophagogastric corrosive lesions
M Noirclerc, J Dicostanzo, B Sastre, L Durif, V Fulachier, D Botta, J Brun and B Drif
Corrosive esophagogastric lesions are common in Algeria and France. Within
the past 14 years, our overall mortality has decreased to 6% as compared to
12% in the best results from elsewhere. This report describes our operative
experience with 68 patients from 1974 to 1982. According to a prospective
interdisciplinary program, lesions in 351 patients were staged by emergency
esophagoscopic findings: Stage I, ulceration; Stage II, hemorrhage and
ulceration; Stage III, mucosal necrosis, hemorrhage, and ulceration. Total
parenteral nutrition or jejunal feeding was given to patients with Stage II
lesions for 3 weeks and to those with Stage III lesions for 3 months before
repeat esophagoscopy. Operations were required by 68 patients who had Stage
III lesions and severe stenosis. Procedures done included 39 retrosternal
colon interpositions, 11 partial or total gastrectomies, nine
esophagogastrectomies, four esophagoenteral colonic bypasses, six
esophagogastric colonic interpositions following partial gastric resection,
and one gastrojejunostomy. Eleven of the cervical anastomoses were to the
pharynx. There were no operative deaths and no anastomotic leaks. All
patients have satisfactory nutrition and rehabilitation. Our operative
experience in the preceding 5 years included an 11% mortality; improved
results in the past 8 years are attributed to early and accurate staging,
planned multidisciplinary management, good nutritional support, and better
timing of operations. Stage III esophagogastric corrosive lesions may be
treated within 4 to 5 months of injury with low mortality and good
functional outcome.
