Surgical approach to corrosive injuries of the stomach

The surgical management of corrosive injuries of the stomach has not yet been clearly defined. This work analyses the results achieved with a surgical protocol included in a new therapeutic approach. This approach applied to 111 consecutive patients was based upon three points: (a) early fibroscopic examination, (b) protection of severe burns by total parenteral nutrition and (c) reparative surgery in the complete healing phase. The stomach was involved in 89 per cent of the 93 cases with proved gastrointestinal lesions; gastric lesions were isolated in 42 per cent of cases. The frequency of gastric involvement is partly related to the type of product ingested; the intensity of lesions is correlated with the quantity and the concentration of corrosive products. After a 3-month total parenteral nutrition period, reparative surgery can be performed without local complications in severe cases. Limited resections of the stomach must then be preferred when possible. In cases with total involvement bypass techniques can be carried out. Indications for early surgery are not yet well defined.