OBJECTIVE: The aim of this study was to describe the technique of colopharyngoplasty for the reconstruction of concomitant esophageal and pharyngeal caustic injuries and to evaluate the postoperative course and late functional outcomes. SUMMARY BACKGROUND DATA: Surgical treatment of esophageal and pharyngeal strictures is a difficult challenge because reconstruction at this level interferes with the mechanisms of deglutition and respiration. Several techniques have been described for the treatment of this condition but none is accepted as the gold standard. METHODS: Fifty-eight patients (34 men, median age 37 years) underwent colopharyngoplasty for caustic injuries between 1993 and 2005. Forty patients (69%) had a previous psychiatric history of depression (n = 30) or schizophrenia (n = 10). After removal of all scar tissues, the pharyngeal reconstruction was performed with the cervical end of the colic transplant employed for esophageal replacement. Laryngeal resection was associated in half of the patients. Success of the procedure was defined as recovery of nutritional autonomy and airway patency. RESULTS: Operative mortality was 2%. Postoperative complications required reoperation in 16 patients (28%). The functional outcome was evaluated in 46 patients with a follow-up of more than 6 months. The tracheostomy was withdrawn in 42 (91%) patients after a median of 42 days (range, 20-1020). The jejunostomy was removed in 32 patients (70%) after a median of 12 months (range, 2-54). Finally, the procedure was successful in 31 patients (67%). Logistic regression analysis showed that advanced age, a previous history of psychiatric disease, and early reoperation had an adverse impact on fuctional outcome. Seven patients (12%) repeated the suicide attempt. CONCLUSIONS: Colopharyngoplasty is a simple and reliable procedure that can be successfully employed to restore the digestive continuity in patients with concomitant esophageal and pharyngeal caustic injuries. Control of the underlying psychiatric disease before reconstruction is a key factor for success.
OBJECTIVE: The aim of this study was to describe the technique of colopharyngoplasty for the reconstruction of concomitant esophageal and pharyngeal caustic injuries and to evaluate the postoperative course and late functional outcomes. SUMMARY BACKGROUND DATA: Surgical treatment of esophageal and pharyngeal strictures is a difficult challenge because reconstruction at this level interferes with the mechanisms of deglutition and respiration. Several techniques have been described for the treatment of this condition but none is accepted as the gold standard. METHODS: Fifty-eight patients (34 men, median age 37 years) underwent colopharyngoplasty for caustic injuries between 1993 and 2005. Forty patients (69%) had a previous psychiatric history of depression (n = 30) or schizophrenia (n = 10). After removal of all scar tissues, the pharyngeal reconstruction was performed with the cervical end of the colic transplant employed for esophageal replacement. Laryngeal resection was associated in half of the patients. Success of the procedure was defined as recovery of nutritional autonomy and airway patency. RESULTS: Operative mortality was 2%. Postoperative complications required reoperation in 16 patients (28%). The functional outcome was evaluated in 46 patients with a follow-up of more than 6 months. The tracheostomy was withdrawn in 42 (91%) patients after a median of 42 days (range, 20-1020). The jejunostomy was removed in 32 patients (70%) after a median of 12 months (range, 2-54). Finally, the procedure was successful in 31 patients (67%). Logistic regression analysis showed that advanced age, a previous history of psychiatric disease, and early reoperation had an adverse impact on fuctional outcome. Seven patients (12%) repeated the suicide attempt. CONCLUSIONS: Colopharyngoplasty is a simple and reliable procedure that can be successfully employed to restore the digestive continuity in patients with concomitant esophageal and pharyngeal caustic injuries. Control of the underlying psychiatric disease before reconstruction is a key factor for success.
Authors: Mircea Chirica; Matthieu Resche-Rigon; Benjamin Pariente; Fabienne Fieux; François Sabatier; Franck Loiseaux; Nicolas Munoz-Bongrand; Jean Marc Gornet; Marie-Dominique Brette; Emile Sarfati; Elie Azoulay; Anne Marie Zagdanski; Pierre Cattan Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584
Authors: Romain Ducoudray; Antoine Mariani; Helene Corte; Aurore Kraemer; Nicolas Munoz-Bongrand; Emile Sarfati; Pierre Cattan; Mircea Chirica Journal: World J Surg Date: 2016-07 Impact factor: 3.352
Authors: Mark Tettey; Frank Edwin; Ernest Aniteye; Martin Tamatey; Ekow Entsua-Mensah; Ernest Offosu-Appiah; Innocent Adzamli Journal: Pan Afr Med J Date: 2015-08-11