Janusz Włodarczyk1, Tomasz Smęder2, Jarosław Kużdżał2. 1. Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Kraków, Poland. jr.wlodarczyk@gmail.com. 2. Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Kraków, Poland.
Abstract
BACKGROUND: Post-burn oesophageal stricture is a late complication, which may require surgical intervention. The aim of the study was to compare gastric and colonic conduits and to evaluate the safety, efficacy and complications of these techniques. METHODS: Retrospective analysis of all patients treated for burn-related oesophageal strictures between 1989 and 2013. Oesophagectomy was performed via laparotomy and right thoracotomy, and/or cervical incision. RESULTS: Forty-six patients, including 29 men, aged 17-67 years (mean: 41 years), had burn-related oesophageal strictures. The post-operative follow-up period ranged between 3 months and 30 years. Colonic transposition was used in 23 patients. In 21 patients, the oesophageal substitute was introduced through the posterior mediastinum, and in two patients the retrosternal route was used. Gastric conduit in was used in 21 patients and jejunal interposition in one patient. One patient underwent segmental oesophageal resection with end-to-end anastomosis. One patient had necrosis of the colonic conduit with anastomotic leakage, two patients had oesophago-colonic anastomosis leakage, five developed anastomotic stenosis, and two had respiratory insufficiency. Among patients with a gastric conduit, anastomotic leakage occurred in four, cervical anastomotic stenosis occurred in two, and respiratory insufficiency occurred in three, and one patient had impaired gastric emptying that required surgical re-intervention. Operative mortality was three patients (6.5%). CONCLUSIONS: The use of colonic and gastric conduit is an effective and safe method for restoring the continuity of the gastrointestinal tract, with an acceptable rate of post-operative complications. Patients who undergo oesophageal resection for post-burn stricture require post-operative systematic endoscopic control.
BACKGROUND: Post-burn oesophageal stricture is a late complication, which may require surgical intervention. The aim of the study was to compare gastric and colonic conduits and to evaluate the safety, efficacy and complications of these techniques. METHODS: Retrospective analysis of all patients treated for burn-related oesophageal strictures between 1989 and 2013. Oesophagectomy was performed via laparotomy and right thoracotomy, and/or cervical incision. RESULTS: Forty-six patients, including 29 men, aged 17-67 years (mean: 41 years), had burn-related oesophageal strictures. The post-operative follow-up period ranged between 3 months and 30 years. Colonic transposition was used in 23 patients. In 21 patients, the oesophageal substitute was introduced through the posterior mediastinum, and in two patients the retrosternal route was used. Gastric conduit in was used in 21 patients and jejunal interposition in one patient. One patient underwent segmental oesophageal resection with end-to-end anastomosis. One patient had necrosis of the colonic conduit with anastomotic leakage, two patients had oesophago-colonic anastomosis leakage, five developed anastomotic stenosis, and two had respiratory insufficiency. Among patients with a gastric conduit, anastomotic leakage occurred in four, cervical anastomotic stenosis occurred in two, and respiratory insufficiency occurred in three, and one patient had impaired gastric emptying that required surgical re-intervention. Operative mortality was three patients (6.5%). CONCLUSIONS: The use of colonic and gastric conduit is an effective and safe method for restoring the continuity of the gastrointestinal tract, with an acceptable rate of post-operative complications. Patients who undergo oesophageal resection for post-burn stricture require post-operative systematic endoscopic control.
Authors: M Cakmak; O Boybeyi; G Gollu; G Kucuk; M Bingol-Kologlu; A Yagmurlu; T Aktug; H Dindar Journal: Dis Esophagus Date: 2014-12-17 Impact factor: 3.429
Authors: Alexander F Hagel; Andreas Naegel; Wolfgang Dauth; Klaus Matzel; Hermann P Kessler; Michael J Farnbacher; Werner M Hohenberger; Markus F Neurath; Martin Raithel Journal: J Gastrointestin Liver Dis Date: 2013-12 Impact factor: 2.008
Authors: J C Goligher; D B Feather; R Hall; R A Hall; D Hopton; T E Kenny; A J Latchmore; T Matheson; J H Shoesmith; F G Smiddy; J Willson-Pepper Journal: Ann Surg Date: 1979-01 Impact factor: 12.969