[Surgical policy for patients with prolonged esophageal burn strictures]

Concept of early radical surgical treatment of prolonged esophageal burn strictures (PEBS) is presented. From 1980 to 2000 one-stage esophagoplasty was performed in 503 (62.0%) of 811 patients with PEBS. Bouginage was effective in 17.2% patients. Extirpation of the esophagus with posteriormediastinal plastic repair was performed in 119 patients. Mean age of patients was 48 years, mean anamnesis time--11 years. 13 (10.9%) patients had total PEBS. Combined burn of the stomach was revealed in 25 (21.0%), of the pharynx--in 4 (3.4%) patients. Isoperistaltic gastric tube was used in 102 (85.7%) patients, whole stomach--in 1 (0.8%), left half of the large intestine (antiperistaltic)--in 16 (13.4%) patients. Esophagectomy was performed transiatally in 114 (95.8%), from three approaches (+ right-sided thoracotomy)--in 5 (4.2%) patients. Transplant on the neck was connected with esophagus in 106 (89.1%) patients, with the pharynx--in 13 (10.9%). Combined operations were performed in 14 (11.8%) patients. Intraoperative complications were in 6 (5.0%), postoperative--in 39 (33.0%) patients. Insufficiency of cervical anastomosis was seen in 16 (13.4%), paresis of recurrent nerve--in 4 (3.4%) patients. Hospital lethality was 3.4% (4 patients). Good and satisfactory long-term results of esophagoplasty were achieved in 97 (97.0%) patients. PEBS is the indication for transhiatal extirpation of the esophagus with its one-stage plastic repair with gastric tube (or large intestine) during first 6 months after burn.