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Esophagojejunostomy after total gastrectomy for caustic injuries
M Chirica1, A Kraemer, E Petrascu
1Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Paris, France.
Summary
Emergency esophagojejunostomy (EJ) is a safe alternative to esophagogastrectomy (EGT) for stomach necrosis from caustic ingestion. Immediate EJ reduces the need for further esophageal reconstruction and hospital stay.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Trauma Management
Background:
- Optimal management of esophageal remnant after caustic-induced gastric necrosis is debated.
- Caustic ingestion can lead to full-thickness gastric necrosis requiring surgical intervention.
- Esophageal injuries often accompany gastric damage, complicating treatment decisions.
Purpose of the Study:
- To compare outcomes of emergency esophagogastrectomy (EGT) versus total gastrectomy with immediate esophagojejunostomy (EJ).
- To evaluate functional success, morbidity, mortality, and need for further reconstruction in patients with caustic gastric necrosis.
- To determine the safety and efficacy of immediate EJ as a primary surgical approach.
Main Methods:
- Retrospective comparison of 26 patients with transmural gastric necrosis (1987-2012).
- Patients underwent either EGT (n=14) or EJ (n=12).
- Outcomes assessed included early/long-term morbidity, mortality, reoperation rates, length of stay, and functional success (nutritional autonomy).
Main Results:
- Morbidity, mortality, and reoperation rates were similar between EJ and EGT groups.
- EJ group had significantly shorter hospital stays (36 vs. 83 days).
- Fewer patients in the EJ group required subsequent esophageal reconstruction (1 vs. 13).
- Functional success rates were comparable (90% for EJ vs. 69% for EGT).
Conclusions:
- Immediate EJ is a safe and effective procedure following total gastrectomy for caustic gastric necrosis.
- EJ reduces the need for complex esophageal reconstruction and shortens hospital stays.
- EJ offers comparable functional outcomes to EGT in this patient population.
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