Surgical Treatment Results of Burn-Related Oesophageal Strictures

• Published in: World journal of surgery 2017-03, Vol.41 (3), p.790-795
• Main Authors: Wodarczyk, Janusz, Smder, Tomasz, Kuda, Jarosaw
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Anastomosis Leakage; Anastomosis, Surgical; Anastomotic Stenosis; Burns, Chemical - complications; Cardiac Surgery; Colon - surgery; Esophageal Stenosis - chemically induced; Esophageal Stenosis - surgery; Esophagectomy; Female; Gastric Conduit; General Surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Oesophageal Stricture; Original Scientific Report; Pleural Empyema; Retrospective Studies; Stomach - surgery; Surgery; Thoracic Surgery; Thoracotomy; Vascular Surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3815-4

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.