Functional outcomes and nutritional status after surgery for corrosive gastric strictures: a 12-year clinical study.
- Jeyan M. , Assistant Professor, Department of Surgical Gastroenterology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Surya Ramachandra Varma GunturiS. , Additional Professor, Department of Surgical Gastroenterology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Mohammed Akheeluddin Khaja , Associate Professor, Department of General Surgery, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Navakishore Kunduru. , Professor, Department of Surgical Gastroenterology, RVM Institute of Medical Sciences and Research Center, Siddipet, Telangana, India.
- Venu Madhav Thumma. , Professor, Department of Surgical Gastroenterology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Sukanya Bhrugumalla , Additional Professor, Department of Medical Gastroenterology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Nirmala Jonnavithula. , Professor, Department of Anaesthesiology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
- Bheerappa Nagari , Professor, Department of Surgical Gastroenterology, Nizams institute of medical sciences, Hyderabad, Telangana, India.
Article Information:
Abstract:
Background: Objectives: To evaluate the long-term surgical outcomes, nutritional status, and quality of life (QoL) in patients with isolated corrosive antral strictures treated with antrectomy and Billroth I reconstruction. Materials and Methods: This longitudinal observational study included 73 patients diagnosed with isolated corrosive antral strictures. All patients underwent antrectomy with Billroth I reconstruction. Postoperative follow-up focused on assessment of functional outcomes, nutritional status (including weight maintenance), and quality of life using standard clinical parameters. Results: The surgical approach demonstrated excellent outcomes, with a 99.4% rate of weight maintenance among patients. Most individuals reported significant improvement in symptoms with minimal long-term complications. Functional recovery was satisfactory, and overall quality of life showed marked improvement during follow-up. Conclusion: Antrectomy with Billroth I reconstruction is a safe and effective surgical option for isolated corrosive antral strictures, providing favorable long-term functional outcomes, excellent nutritional status, and improved quality of life.
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Article :
INTRODUCTION:
Corrosive ingestion remains a significant public health issue in developing countries, leading to debilitating strictures of the upper gastrointestinal tract. While the esophagus is a common site of injury, concentrated acids frequently "lick the esophagus and bite the pyloric antrum," causing isolated gastric involvement due to pylorospasm and prolonged contact time in the dependent portion of the stomach. When these strictures are non-dilatable, definitive surgical intervention is required to restore alimentary continuity. This study investigates the long-term physical and functional outcomes for patients specifically undergoing surgery for isolated corrosive antral strictures.
Aim & objective:
To assess the functional outcomes and nutritional status after surgical intervention in patients with gastric strictures secondary to corrosive ingestion.
MATERIALS AND METHODS:
This single-center, ambispective study analyzed a cohort of 73 patients (representing 40.6% of a larger corrosive injury study) treated at a tertiary care center between 2012 and 2023. All patients were diagnosed with corrosive antral strictures.
The standardized surgical procedure performed for this entire subgroup was Antrectomy + Billroth I reconstruction. Long-term functional outcomes were assessed using a modified and adapted version of the EORTC QLQ-OG 25 questionnaire, administered at least one-year post-surgery. Evaluation focused on nutritional rehabilitation, specifically weight maintenance, and the prevalence of discrete symptoms such as dysphagia, reflux, and coughing. Data were gathered through a combination of retrospective medical record reviews and prospective follow-up assessments.
RESULTS:
• Patient demographics: The mean age of the participants was 30.7 years (median 27.5 years). The follow-up period ranged from 2 to 13 years, with a mean duration of 8.9 years.
• Surgical safety: The immediate post-operative complication rate for the antrectomy group was 9.6%. All recorded complications were classified as minor, including fever, surgical site infections (SSI), and transient vomiting.
• Nutritional and functional outcomes:
• Weight maintenance: An exceptional 100% of patients successfully maintained their weight gain in the long-term follow-up period.
• Swallowing and eating: The majority achieved excellent swallowing function. Only a small minority reported having difficulties with solid foods (4.1%).
• Symptomatic profile: Procedure-related symptoms were notably low. Coughing was reported by only 1.4% of patients. Furthermore, symptomatic reflux, including heartburn and acid/bile regurgitation, was absent (0%) in this group.
• Psychosocial Status: Psychological distress was minimal, with 2.7% reporting feeling "physically less attractive" and 0% reporting "illness thoughts".
DISCUSSION:
The surgical management of corrosive antral strictures via Antrectomy + Billroth I reconstruction provides excellent long-term alimentary satisfaction. The low complication rate observed in this study (9.6%) underscores the safety of the procedure when compared to more extensive reconstructions.
The high rate of nutritional rehabilitation, demonstrated by universal weight maintenance (100%), indicates successful restoration of oral feeding and alimentary autonomy. The functional superiority of this reconstruction is further highlighted by the complete absence of reflux symptoms and the minimal incidence of coughing (1.4%), suggesting that preserving the proximal stomach and utilizing Billroth I reconstruction maintains a high physiological quality of life.
The results suggest that a multidisciplinary approach, including preoperative optimization and an adequate waiting interval (approximately four months) before surgery, contributes to these favorable long-term outcomes.
CONCLUSION:
Antrectomy + Billroth I is a highly effective and safe surgical intervention for isolated corrosive antral strictures. It leads to superior long-term functional results, robust nutritional restoration, and high levels of patient satisfaction, making it the preferred procedure for this specific patient population.
A multidisciplinary team effort with good pre-habilitation, thorough evaluation and psychological counselling is the key for good outcomes.