ESOPHAGEAL REPLACEMENT IN THE MANAGEMENT OF CORROSIVE STRICTURES - WHEN IS SURGERY INDICATED

The accidental ingestion of corrosive agents is a major cause of oesop hageal strictures in children. The mainstay of treatment is repeated d ilatations. Despite this, a significant number of patients eventually require oesophageal bypass. We reviewed the records of all cases manag ed with this condition at the University of Cape Town teaching hospita ls between 1976 and 1994. Dilatation therapy alone was successful in 1 4 out of 39 patients (41%). Morbidity of failed dilatation therapy inc luded repeated hospital admissions over an average 11.5 months and 17 dilatations each. Oesophageal perforations occurred in 7 cases (18%). Early factors predictive of failure of conservative treatment were: de lay in presentation of more than 1 month; severe pharyngo-oesophageal burns requiring a tracheostomy; oesophageal perforation; and a strictu re longer than 5 cm on radiological assessment. The size of dilators a ccepted during early bougienage also correlated with eventual outcome. These criteria may be useful in predicting which patients will not re spond to repeated dilatations. Early surgical intervention in such cas es will prevent fruitless dilatations and related complications.