315. LAPAROSCOPIC GASTRIC PULL-UP WITH GASTROJEJUNOSTOMY AS AN ALTERNATIVE TO COLON-TRANSPOSITION FOR CORROSIVE STRICTURE INVOLVING OESOPHAGUS AND ANTROPYLORIC REGION OF STOMACH

Background

Various gastrointestinal segments are used for replacement of the scarred oesophagus following corrosive ingestion. Colon is preferred if scarring involves both the oesophagus and the stomach, however, in some patients only the antral part of the stomach maybe involved (in addition to the oesophagus), and a gastric pull-up with a roux en Y gastrojejunostomy may also be feasible.

Methods

Retrospective analysis of corrosive strictures managed surgically between 2020–2023. The short and long-term outcomes of laparoscopic gastric pull-up with roux en Y gastrojejunostomy (LGPU-GJ) were compared with colonic pull-up.

Results

During the study period, 45 patients underwent surgical management for corrosive injury to the oesophagus and stomach. Of these, 7 patients underwent a LGPU-GJ (group A) and 20 patients underwent a colonic pull-up (Group B) and formed the study group. The mean operative time and blood loss was (195.7 ± 55 and 322 ± 63 min, p = 0.001; 48.5 ± 24 and 108 ± 30.8 mL p < 0.001) in Group A and B respectively. One patient in Group A had a gastric staple line leak which was managed with intercostal drainage and antibiotics, 3 patients in Group B had cervical anastomotic leak which was managed conservatively. There was no mortality.

Over a median followup of 18 months, 2 patients in Group A and 7 in Group B required at least one session at endoscopic anastomotic dilatation. There were no significant reflux symptoms reported and all patients were able to tolerate a standard Indian diet.

Conclusion

In a select group of patients with concomitant oesophageal and isolated gastric antral stricture a laparoscopic gastric pull-up with roux en Y gastrojejunostomy may be a feasible alternative to the more complex colonic pull-up with shorter operative times, less blood loss and equivalent outcomes.