Surgical treatment and its long term result of caustic-induced prepyloric obstruction

Objective. To present our long term results of the treatment of caustic-induced prepyloric obstruction, and to set out guidelines for the management of such patients. Design: Retrospective study. Setting: General hospital (medical centre), Taiwan. Subjects: 30 patients (8 male and 22 female, mean age 34 years, range 13-62) who developed prepyloric obstruction out of 271 treated for caustic injuries of the upper gastrointestinal tract. Interventions: Gastrojejunostomy (n = 24), antrectomy and Billroth I reconstruction (n = 4), and antrectomy and Billroth II reconstruction (n = 2). Four patients required second operations: oesophageal reconstruction for stricture (n = 3), and gastrojejunostomy for restenosis of Billroth I anastomosis (n = 1). Main outcome measures: Morbidity and mortality. Results: No patient died postoperatively, and there were three complications-wound infection, internal bleeding, and stenosis of the Billroth I anastomosis. 21 patients were able to enjoy their normal diet postoperatively, 5 required periodic dilatation of oesophageal strictures, and 4 required further operations. Conclusions: Gastrojejunostomy gives good long term results as long as there is no oesophageal stricturing, and morbidity and mortality are low. The long term outcome is dependent on the degree of oesophageal involvement.