Management of caustic pharyngoesophageal injuries in Korle Bu Teaching Hospital, Accra, Ghana: a 12-year retrospective review of 29 cases

Abstract

Introduction: caustic pharyngoesophageal strictures are life-threatening injuries with important management difficulties, lacking clear therapeutic guidelines. The aim of this study is to evaluate the surgical procedures and outcomes of severe caustic pharyngoesophageal strictures in our institution. Methods: a total of 29 patients who underwent surgery for severe caustic pharyngoesophageal injury at the National Cardiothoracic Center from June 2006 to December 2018 were retrospectively reviewed. The age distribution, sex, management procedures, complications after surgery, and the outcome were analyzed. Results: there were 17 males. The mean age was 11.7 years (range 2- 56 years). All patients accidentally swallowed caustic soda, except the oldest patient who ingested an unidentified substance. The treatment procedures included colopharyngoplasty in 15 (51.7%) patients, colon-flap augmentation pharyngoesophagoplasty (CFAP) in 10 (34.5%), and colopharyngoplasty with tracheostomy in 4 (13.8%). There was one case of graft obstruction from a retrosternal adhesive band and one case of postoperative reflux with nocturnal regurgitation. No cervical anastomotic leak occurred. Rehabilitative training for oral feeding was required for less than a month in most patients. Follow-up period ranged from one to twelve years. Four patients died within this period; two were immediate post-operative deaths and two occurred late. One patient was lost to follow-up. Conclusion: outcome of surgery for caustic pharyngoesophageal stricture is satisfactory. Colon-flap augmentation pharyngoesophagoplasty reduces the need for tracheostomy before surgery, and our patients start eating early without aspiration.