Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature.
INTRODUCTIONExploratory laparotomy whether elective or emergency has always remained one of the common operations across the surgical disciplines. The closure of such a laparotomy wound is key to reduce the post-operative morbidity like wound pain, wound infections and incisional hernias.1 Wound dehiscence carries with it a substantial morbidity and mortality. Mortality associated with burst abdomen has been estimated at 16%.2 The mean time for wound dehiscence is 8-10 days after operation.2,3 Abdominal wound dehiscence is a common complication of emergency laparotomies in Indian setup.Wound dehiscence is related to technique of closure of abdomen. Many patients in India have poor nutritional status and the presentation of patients with peritonitis is often delayed. This makes the problem of wound dehiscence more common in Indian setup.4 Post-operative complete wound dehiscence is a very serious complication associated with high morbidity and mortality. 5 The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. To date, various randomised clinical trials and meta-analysis have been published with heterogeneous results. While the choice may not be so important in elective patients who are nutritionally ABSTRACT Background: Abdominal wound closure technique should be efficient to perform, provide strength and be a barrier to infection. The method of closure of the abdominal wall is a critical aspect of an effective incision closure, in addition to the choice of suture material. Abdominal wound dehiscence is a common complication of emergency laparotomy. This study was done to know whether our method of abdominal closure was helpful in reducing incidence of burst abdomen. Methods: This retrospective study was carried out in the department of general surgery in a tertiary medical centre in Mumbai. 126 Patients undergoing emergency laparotomies for extensive generalised peritonitis through a vertical midline incision were included in this study; the indications for laparotomy were inflammatory, traumatic and neoplastic. Results: Out of 126 patients undergoing closure of laparotomy wound by our method, wound infection was noted in 12 (9.52%) cases and 3 (2.38%) patients developed wound dehiscence (burst abdomen). Conclusions: This retrospective study demonstrates that our method of abdominal closure was helpful in reducing the incidence of burst abdomen post-operatively. This is of extreme clinical importance in reducing morbidity, mortality and healthcare cost related to abdominal wound dehiscence in a patient undergoing emergency laparotomy.
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