Oesophagectomy for severe corrosive injuries: is it always legitimate?

Twenty total gastric resections were performed on 80 patients admitted to surgery for severe oesophagogastric corrosive injuries, with immediate or delayed full-thickness necrosis or perforation of the stomach. The duodenum, cardia and cervicothoracic oesophagus were sutured. A cervical oesophagostomy and a feeding jejunostomy were done. The oesophagus was thus excluded. All the corrosive agents were liquid. The ingested quantities were higher than 150 ml in 11 cases. Oesophagoscopy was performed in 12 patients: 4 lesions were stage III, 5 stage II, 2 stage I, while in 1 the mucosa appeared normal. Five patients died, but only 1 from an oesophageal complication, an oesophago-tracheal fistula on the 33rd post-operative day. The survivors had a secondary colon bypass and 5 patients developed a secondary mucocele. We suggest that the low incidence of tracheo-oesophageal fistula in our series and the possible formation of a mucocele in the excluded oesophagus are two arguments for a conservative attitude towards the oesophagus in most cases of emergency gastric surgery for corrosive lesions. Immediate oesophagectomy adds another traumatic factor to the effects of the burns. A subsequent oesophagectomy should be contemplated during coloplasty to prevent the formation of a mucocele.