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The Surgical Strategy in Massive Corrosive Injury in Digestive Tract: Is the Extensive Surgery Appropriate?

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Abstract

Background

Corrosive ingestion results in necrosis of the digestive tract, spillage of intraluminal fluid, and spread of bacteria that threatens the lives of patients. Some authors advise extensive surgery, although others recommend conservative operation. This study presents the outcomes of the patients of corrosive injury who undergo emergent surgery.

Methods

We conducted a retrospective review including patients with corrosive injury from Jan 2007 to Dec 2013. We retrieved and analyzed the demographic characteristics, injury location and extent, endoscopic grade, presence of surgery, surgical timing and procedure, and mortality.

Results

The cohort consisted of 112 patients; 23 of the patients underwent an emergent operation. Patients who needed emergent surgery had the worse endoscopic severity and a higher mortality rate of 47.8% (12/23). Perforation of the digestive tract [odds ratio (OR) 13.5, p = 0.011] and unscheduled reoperation (OR 13.2, p = 0.033) were factors that predict mortality.

Conclusion

Corrosive injury resulted in a dismal prognosis, especially when patients required an operation. The mortality is related to digestive tract perforation and unscheduled reoperation. Inadequate resection might lead to unscheduled reoperations, which lead to a dismal prognosis.

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Abbreviations

CT:

Computed tomography

HLOS:

The length of hospital stay

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgements

The authors thank Fen-Ping Kuo, Chun-Ju Chen, and Hui-Chen Tien, members of the CGMH acute abdomen registry databank, who contributed to the data collection for this study. We thank the members of corrosive injury team in CGMH to give us clinical opinions and consultation. We also acknowledge the involvement of the participants, without whom this research could not have been conducted.

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Author notes

  1. Yung-Hung Chang and Chih-Ying Chien have contributed equally to this work.

Authors and Affiliations

  1. Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

    Yung-Hung Chang, Chih-Yuan Fu, Chi-Hsun Hsieh & Chien-Hung Liao

  2. Chang Gung University, Taoyuan, Taiwan

    Yung-Hung Chang, Chih-Ying Chien, Chih-Chi Chen, Chih-Yuan Fu, Chi-Hsun Hsieh & Chien-Hung Liao

  3. Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

    Chih-Ying Chien

  4. Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan

    Chih-Chi Chen

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  1. Yung-Hung Chang
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Correspondence to Chien-Hung Liao.

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Chang, YH., Chien, CY., Chen, CC. et al. The Surgical Strategy in Massive Corrosive Injury in Digestive Tract: Is the Extensive Surgery Appropriate?. World J Surg 42, 2028–2035 (2018). https://doi.org/10.1007/s00268-017-4451-3

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