Surgical management of post-corrosive gastric outlet obstruction: Outcome assessment in adults and pediatric patients in resource-limited settings.

Abstract

Objective: This study aims to evaluate the outcomes of surgical treatment in adult and pediatric patients with post-corrosive gastric outlet obstruction (GOO) in Yemen.

Patients and methods: A prospective observational study was conducted at Al-Thawra Modern General Hospital (TMGH), from January 1, 2019 to January 31, 2023. The study involved 77 patients, comprising both adults and children, who were admitted for surgical treatment of post-corrosive GOO. Data were collected from medical records, patient interviews, and follow-up visits.

Results: Among the 77 patients, 77% (n = 59) were pediatric patients and 23% (n = 18) were adults. The mean age of the cohort was 10.6 years, with an average age of 4.12 years for pediatric patients and 30.8 years for adults. The primary cause of post-corrosive GOO was the accidental ingestion of acidic substances, accounting for 97% of cases. Common symptoms at presentation included vomiting, early satiety, and weight loss. Definitive surgery was performed in one stage in 95% of patients, with Heineke-Mikulicz pyloroplasty being the most common procedure (82%) in pediatric cases, whereas gastrojejunostomy was mainly used in adults (67%). Postoperative complications occurred in 22% of patients, with vomiting, wound infection, and aspiration pneumonia being the most common. Anastomotic restriction was observed in two pediatric patients who required reoperation. The overall mortality rate was 1.3%, with one pediatric patient having succumbed. Notably, improvements in GOO symptoms were observed in 96% of patients. Pediatric patients had a longer median hospital stay (6.5 days) than adult patients (6 days).

Conclusion: Corrosive injuries, particularly in the pediatric population, pose a significant issue in Yemen due to the unsafe storage of sulfuric acid. It is recommended to conduct early surgical interventions within 4 weeks after ingestion to prevent weight loss and to reduce prolonged hospitalization. Further research and interventions are needed to prevent such injuries, improve public awareness, and regulate the sale and storage of corrosive substances.