ELECTIVE SURGERY FOR CORROSIVE-INDUCED GASTRIC INJURY

Gastric cicatrization is a well recognized late sequela of corrosive g astric injury, but the optimum timing and type of surgery for this com plication are still unclear. Over a 7-year period (1988-1994) 33 patie nts underwent elective surgery for gastric lesions secondary to corros ive ingestion. A total of 18 (53%) patients had an associated esophage al stricture and presented with dysphagia, 15 (41%) patients had featu res of gastric outlet obstruction, 6 (18%) had diffuse gastric injury, and 28 (82%) had a segmental lesion. A tube jejunostomy was done in 2 3 (68%) patients to improve nutrition and resulted in a significant in crease in weight and in the serum protein level after 8 weeks of tube feeding. Elective surgery was performed 3 to 23 months (average 7 mont hs) after ingestion of the corrosive substance. Gastric resection was done in 20 (59%) patients and gastrojejunostomy (without vagotomy) in 11 (32%); at follow-up the latter group did not exhibit development of a stomal ulcer. In patients with an associated esophageal stricture, endoscopic dilatation was successful in 89% patients and simplified th e surgical approach. In conclusion, the success of surgery for corrosi ve-induced gastric injury depends on selecting the right procedure and intervening at the appropriate time.