Comparison of the Quality of life (QoL) following reconstructive conduit surgeries(interposition coloplasty vs. gastric pull up) for patients with corrosive strictures of the oesophagus

Volume : VI, Issue : VIII, August - 2017

Bennet Duraisamy, Amarjothi J M V, Amudhan Anbalagan, Kannan D, S. M. Chandramohan

Background:. The aim of the study is to analyze and compare the Quality of life (QoL)following the two

different reconstructive surgeries viz. gastric pull up and interposition coloplasty undertaken for patients with

corrosive injuries of the esophagus at the end of the first post operative month and year.

Patients and Methods: Between August 2008 and December 2015 , 56 patients underwent reconstructive

surgery for intractable strictures of oesophagus ,of whom , 44 patients were amenable for regular followup. Of

these patients , 32 underwent coloplasty and 12 underwent gastric pull up depending on concomitant caustic

involvement of stomach . The patients filled two questionnaires including :1) Short form Health survey SF–36

to assess general quality of life2)and a specifically designed ,previously unvalidated questionnaire which we

believe addresses the quality of life in an appropriate social context.This is a checklist containing items

reflective of patients general symptoms , reflux related symptoms, perceived weight gain after procedure ,

perceived body image after procedure and overall social and psychological well being.

Results: At one month duration, the mean of all scales in SF 36 are low reflective perhaps of the poor quality

of life perceived by most patients and the subscales of the SF 36 Questionnaire are not different when compared

between coloplasty and gastric pull up. At the one year period, however , the mean of patients undergoing

coloplasty is significantly better (p<0.05) when compared to gastric pull up with respect to all subscales of the

SF –36 .

On analysis of the special questionnaire at 1 month,,coloplasty patients performed better with regard to most

physical symptoms . Also, coloplasty patients had significantly less social and mental impairment when

compared to gastric pull up On analysis of the special questionnaire at 1 year , it was seen that coloplasty

patients perform better on most questions relating to physical and reflux symptoms with better mental state ,

perceived weight gain. And body image . However, coloplasty patients had more self noticeable neck swelling

and the frequent hold up of food was still statistically significant. .

Conclusion:. There is significantly better QOL reflected by both the questionnaires for coloplasty patients at the

1 year interval when compared to the gastric pull up patients ..Though there is a theoretical increased risk of leak

in coloplasty patients, owing to the increased number of anastomosis when compared to gastric pull up , they can

be done in experienced centres with minimal morbidity.

In India ,where concentrated acid injury causing corrosive stricture of the oesophagus with concomitant stomach

involvement is very common than the West ,coloplasty may be the preferred reconstructive conduit surgery in

the long term at centres of excellence if the short term morbidity of coloplasty can be tided over.