POSTBURN CICATRIAL STRICTURES

R.E. LIGAY, L.P. STRUSSKIY, J.A. HAJIBAYEV, B.A. YANGIYEV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Purpose: To study causes and results of treatment of esophageal injuries in patients with post-burn cicatricial esophageal strictures (PCES).

Materials and methods: 439 patients with the PCES were treated at the department of esophageal and gastric surgery in the period from 1991 to 2010. Injury of the esophagus and gastric cardia occurred in 20, i.e. 4.5% of patients. Only in 1 patient injury occurred during an independent bougienage with a plastic tube, and in remaining 19 - injury was of iatrogenic nature. Reasons of iatrogenic injuries included: endoscopic examination - in 5; endoscopic bougienage in 7; bougienage along a string - in 4; blind bougienage in 1; introduction of a string for further bougienage in 2.

The diagnosis of the injury was set on the basis of complaints, anamnesis and objective observation. To determine the exact localization of the perforation there were performed endoscopic and radiographic examination with a water soluble contrast.

Results and discussions: Conservative treatment of two patients was successfully completed in 2 patients which did not have purulent mediastinitis, and the length of a false passage did not exceed 1 cm. Successful surgical treatment of these patients depends on the terms of the operation. Thus, within the first 6 hours there were operated - 13 patients, from 6 to 12 hours - 3, two patients which were at a critical condition from other hospitals operations were performed on 5 and 10^th days.

In 18 patients there were diagnosed serious complications of the esophageal perforation: neck phlegmon in 1, diffuse purulent peritonitis in 1,serous mediastinitis in 4; purulent mediastinitis in 12; pleural empyema in 4 and esophago-mediastino-pleural fistula in 1 patient.

Surgical approach depended on the time from the moment of perforation; severity of the patient’s condition; localization of esophageal damage; the degree of development of pyoinflammatory changes in the wall of the esophagus and mediastinum. The nature of 18 surgery was it the following: suturing of the defect of the esophagus with drainage and mediastinal plugging in 8, sanitation, drainage and plugging of the mediastinum - in 9, suturation of the defect of cardia, sanitation, drainage of the abdominal cavity – in 1 patient. In all cases, there was inserted gastrostomy.

Fatal outcome occurred in 5 of 20 patients, i.e. 25%. Reasons of fatal outcomes included ongoing purulent mediastinitis and pleural empyema in 4 cases, as well as diffuse purulent peritonitis in 1 patient.

Conclusion: Surgical treatment of patients must be strictly individual and depend on the severity of the conditions of the patient, time passed from the moment of injury, as well as the nature of septic complications.

Date: 2014-12-28; view: 933