Ana Sayfa » Yayın Arşivi » Türk Otolarengoloji Arşivi » 1984 » Surgical Treatment of Chemical Burns of the Oesophagus
 

Surgical Treatment of Chemical Burns of the Oesophagus

Cebeci H.

Operative treatment for chemical oesophageal burnsis not done frequently but certain early and late complications are required operative intervention. In the acute period a number complications may occur. We must be alert to the possibility of their occurrence. The patient should be looked closely for laryngeal adema during the first 3 and 5 days after injury. Long, dense sstructures which do not respond to bougienage make the eosophagus an unsatisfactory conduit for the passage of food from the pharynx to the stomach. Ön the other hand if the lesion is obviously nondilatable the patient is candidate for surgical treatment.The results of operative serier indicate the desirability of prompt and safe reconstitution of the swallowing action. Nutrition is maintained and the patient avoided from the psychic and the hazard of frequent and numerous dilations.However the preoperative satge ust never bu hurried and an adequate gcstrostomy must be performed and the patient should regain his normal weight. The indications for surgical treatment are stated as follows: 1- An esophagus with complete stenosis in which antero-retrogread dilation shave failed to establish an adequate lumen; 2- An oesaphagus with very severe irregularity and pocetin; 3- An oesophogus which cannot be dilated without the development of a severe perioesophageal reaction or mediastinitis; 4-The condition that the fistula is present on the oesophageal wall; 5-The cases who cannot be maintained or be obtained a lumen above a 4/-Fr bougie of the oesophagus by dilation; 6-The patients who are unwilling or unable to undergo the prolonged period of dilatition. Because of the decreasing morbidity and mortality after the surgical treatment the indications for operation have been gradually extended. It should not be persisted in attempts to dilate an oesophageal stricture over a long enough period sisted in attempts to dilate an oesophageal stricture over a long enough period of time particularly when progres is not well and especially medical treatment and bougienage is irregular due to the attitude or economic status of the patient or his parent. There are several equally satisfactory procedures. All an insufficient number of cases who cannot be obtained an adaquate lumen by dilatation or are complications, can be treated by any one procedure which is selected by surgeon. At the sametime the operation of choice is influenced by the circumstances in each individual patient. The surgical procedures availeble for treating patients with severe stenosis of he oesophagus are stated as follows: a Heineke-Mikuliez type oesophagoplasty (for short strictures only); local resection of the stricture for short strictures only and end-to-end oesophago-oesophagostomy; resection of the damaged oesophagus and reconstruction with a segment of jejunum or colon or with eosophago-gastorstomy; paypass of the stricture with utilitation of the stomach, jejunum, or colon currently operation employed while the damaged oseophagus is left in place; a Thal type of gastric serosal patch gusset, which can be performed on only for strictures that are limited the lower portion of the oesophagus. The surgeon should keep in mind which one is better in making the decision between continued boufienoge and operation. We report four patients who have developed oesophageal stricture from the swallowing of corosive material.Three of these patients are children. One patient is adult. Dilatation has been performed in three children.In one child bouginage was unsatisfactory and in this case oesophagolpasty was carried out. In two other children oesophageal strictures were dilated successfully by bougienage. Distal oesophageal and proximal gastric stricture occured in the adult patient. Bougienage was not performed in the last patient. Resection of the distal oesophageal and proximal gastric stenosis with end-to-end oesophago-gastrostomy was carried out in the adult.

Türk Otolarengoloji Arşivi 22 (Supl.)/ 26-27

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