OUTCOMES OF BOUGIENAGE IN THE LATE POST-BURN PERIOD IN PATIENTS WITH COMBINED CICATRICIAL STRICTURES OF THE PHARYNX, ESOPHAGUS, AND STOMACH WITH PREDOMINANT CLINICAL PRESENTATION OF PHARYNGEAL AND ESOPHAGEAL OBSTRUCTION

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 9 SEPTEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 46 OUTCOMES OF BOUGIENAGE IN THE LATE POST-BURN PERIOD IN PATIENTS WITH COMBINED CICATRICIAL STRICTURES OF THE PHARYNX, ESOPHAGUS, AND STOMACH WITH PREDOMINANT CLINICAL PRESENTATION OF PHARYNGEAL AND ESOPHAGEAL OBSTRUCTION Z.M. Nizamkhodjaev1, R.E. Ligai2, J.A. Khadjibaev3, R.R. Omonov4, A.O. Tsoy5, A.D. Abdukarimov6, J.M. Avalbaev7, Sh.N. Madrakhimov8, S.D. Iskandarov9, Yu.G. Yusupov10 The State Institution "Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov"1,2,3,4,5,6,7,8,9,10 https://doi.org/10.5281/zenodo.17275502 Abstract. The article presents the experience of treating patients with combined post-burn strictures of the pharynx, esophagus and stomach, in whom the clinical picture of pharynx/esophagus obstruction in the late post-burn period was predominant. The authors present the results of esophageal bougienage in patients with different localizations of cicatricial strictures in the pharynx and esophagus. Key words: chemical burn, combined cicatricial strictures of the pharynx and esophagus, esophageal bougienage, gastrostomy, shunt coloplasty Introduction Patients and those affected by this condition take various acids (usually acetic essence - 53.6-85.6%) and alkalis (in a glass of all sodium hydroxide - 18-38.6%), as well as 14% of unknown toxic substances. Patients with chemical diseases of the stomach and stomach make up all hospital toxicological classifications, of which more than 70% are patients with a predominance of clinical manifestations of damage to the stomach, and 32% - stomach. It should be understood that the severity of lesions and the prevalence of gastric disease and associated selucid stricture names of the esophagus and stomach depend on several factors: "from the amount and concentration of aggressive fluid, its viscosity, its viscosity and its resorptive action." It is to study the results of bougienage in the late permanent period in patients with combined cicatricial strictures of the pharynx, esophagus and fluid with a predominance of the clinic of obstruction of the pharynx and esophagus. Materials and methods: In the surgical department of the stomach and stomach, surgical treatment was performed on 398 patients with PRSP who were inpatients and treated at the State Institution "Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V.V. Vakhidov" from 2000 to 2023. It has been increasingly acknowledged that the distribution of patients by gender and age was as follows: 155 men (38.9%), 243 women (62.1%), the average age was 34.4 ± 0.66 years. Analytical analysis of 398 patients with combined PRSP, the nature of the ingested was as follows: the largest number was made up of patients who ingested vinegar essence - 265 (66.6%) patients, in second place, the cause of the burn was the intake of various alkalis - 72 (18.1%) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 9 SEPTEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 47 patients, 34 patients, 8.6% of patients, did not smoke, the chemical reagent was typical for the substance, sulfuric acid was the cause of the problem in 22 (5.5%) patients, in 5 (1.2%) patients internal hydrochloric acid was noted. When observing 398 patients, it was found that cicatricial stricture was distributed throughout the stomach, so pharyngeal strictures were observed in 16.3% of patients, stomach - in 62%, and pharynx and stomach - in 21.6%. Table 2 presents the distribution of the disease and localization of the cicatricial process, as well as its combined lesion of the pharynx and stomach. Table 2 Localization of cicatricial stricture in the esophagus Combined cicatricial stricture Esophagus Pharynx 65(16,3%) Stomach 247(62%) Pharynx + stomach 86(21,6%) Total 398(100%) From Table 2, the most common was combined cicatricial stricture of the esophagus and stomach and was diagnosed in 247 (62%) patients. In second place in terms of frequency of occurrence, there was combined cicatricial stricture of the pharynx and stomach and was diagnosed in 86 (21.6%) patients, combined stricture of the pharynx and esophagus was observed in 65 (16.3%) patients. It is widely known that the formation of cicatricial stricture occurs within 6 months from the moment of the burn. The time of the patient's appeal for medical help from the moment of the burn is important. Surgical tactics in the early post-burn period, i.e. within 6 months and in the late post-burn period after 6 months are fundamentally different. In this regard, the patients were divided depending on the time of admission. The distribution of patients by the time of admission to the hospital from the moment of the burn was as follows: in the early post-burn period up to 6 months, 171 patients sought help, which was 43%. In the late post-burn period, at a time of 6 months or more, 227 (57%) patients sought help. It is becoming more evident that in our study, we decided to combine patients with a predominance of the clinic of obstruction of the pharynx and esophagus, due to the fact that in both cases, the main complaint upon admission to the hospital was dysphagia, and the treatment tactics were identical. Since during bougienage of the esophageal stricture, bougienage of the pharynx occurs simultaneously and vice versa. In cases where bougienage is not effective or impossible, shunt pharyngocoloplasty is performed. In terms of the number of patients, this is the largest group, since we included 65 patients with combined post-burn strictures of the pharynx and esophagus, 101 patients from the group with combined cicatricial strictures of the esophagus and stomach, and 50 patients from the group with combined cicatricial strictures of the pharynx, esophagus and stomach, since all of these patients had predominantly esophageal obstruction. There is increasing awareness that the pharynx and esophagus with their physiological constrictions are the first natural barrier on the way of the chemical reagent downwards, in connection with which the greatest cicatricial changes are diagnosed precisely in the pharynx and esophagus. From the 398 patients, 216 (54.3%) patients had a predominant clinical picture of esophageal obstruction. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 9 SEPTEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 48 From the 216 patients with a predominant clinical picture of esophageal obstruction, 87 patients sought help in the late post-burn period, which was 40.3%. As in the early post-burn period, dysphagia was the predominant symptom in all 87 patients. However, the latter was more pronounced. The distribution of patients by the degree of dysphagia is presented in Table 3. Table 3 Distribution of patients by the degree of dysphagia. Degree of dysphagia I II III IV PRSG+P (n=27) 1 9 13 4 PRSP+F (n=41) 2 17 16 6 PRSG+P+F (n=19) - 9 8 2 TOTAL (n=87): 3(3,5%) 35(40,2%) 37(42,5%) 12(13,8%) From Table 3, grade I dysphagia was observed in 3 (3.5%) patients, grade II dysphagia in 35 (40.2%), grade III dysphagia was reported by 37 (42.5%) patients, and grade IV dysphagia in 12 (13.8%). Results and discussion: It has long been accepted that all 87 patients with combined pharyngeal, esophageal, and gastric strictures with predominant esophageal obstruction clinical features, in the late post-burn period, also began treatment with bougienage along a guidewire (Fig. 1). The results of bougienage depending on the stricture localization are presented in the table Table 4.11 Results of esophageal bougienage Good result Satisfactory result Unsatisfactory result PRSG+P (n=27) 3(11,1%) 5(18,5%) 19(70,4%) PRSP+F (n=41) 24(58,5%) 7(17,1%) 10(24,4%) PRSG+P+F (n=19) 2(10,5%) 1(5,3%) 16(84,2%) TOTAL (n=87): 29(12,6%) 13(6,9%) 45(80,5%) In this case, good results were achieved in 29 (12.6%) patients, satisfactory in 13 (6.9%) patients and unsatisfactory in 45 (80.5%) patients. Figure 1. A set of hollow radiopaque bougies with a string and an X-ray image of bougienage along the string. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 9 SEPTEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 49 The number of patients with late burns who required surgical intervention was significantly higher and amounted to 45 (80.5%) patients. Of these, given the pronounced alimentary exhaustion, in 16 (35.6%) cases a gastrostomy was applied (Fig. 1a) as a preparatory stage for shunt esophagoplasty. In 29 (64.4%) cases, reconstructive and restorative surgeries were performed. In the remote period, which was monitored for up to 5 years, not a single patient needed surgery on the stomach, due to the fact that cicatricial stenosis in the stomach wall did not progress. From 47 patients from the group with early burns and 16 patients from the group with late burns, who had previously had a gastrostomy, reconstructive and restorative surgeries were subsequently performed, already in the late post-burn period. Conclusion There is growing consensus that in case of cicatricial strictures of the esophagus of postburn genesis, with a predominance of the clinical picture of pharynx or esophagus obstruction, regardless of the time since the burn, treatment should be started with minimally invasive treatment methods. 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