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

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.