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Reoperation after esophageal replacement in childhood
J C Dunn1, E W Fonkalsrud, H Applebaum
1Division of Pediatric Surgery, UCLA School of Medicine and Department of Surgery, Kaiser Permanante, Los Angeles, CA 90095, USA.
Insights
Reoperations after esophageal replacement in children are complex but often lead to good outcomes. Surgical revisions for strictures and fistulae improve function, with advanced techniques available for graft failure.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Esophageal replacement surgeries in children can lead to significant complications requiring further interventions.
- Reoperation is sometimes necessary to address morbidity following initial esophageal replacement.
Purpose of the Study:
- To review the management and outcomes of pediatric patients who required reoperation after esophageal replacement.
- To analyze the types of reoperations performed and their associated functional results.
Main Methods:
- Retrospective review of 18 pediatric patients who underwent esophageal replacement between 1985 and 1997.
- Analysis of 10 patients who underwent reoperation, focusing on management, perioperative morbidity, and dietary intake at follow-up.
Main Results:
- Reoperations were performed for various reasons including esophageal atresia, caustic ingestion, and achalasia.
- Common initial replacements included colon interposition and reverse gastric tube; 7 patients needed anastomosis revisions.
- Complex reconstructions like gastric transposition or free jejunal grafts were used for graft failure; 7/10 patients achieved good oral intake.
Conclusions:
- Esophageal replacement remains a challenging procedure with potential for significant complications.
- Reoperative strategies primarily address strictures and fistulae, with reconstructive options for graft failure.
- Despite associated morbidity, most pediatric patients achieve a good functional outcome after reoperation.
Background:
Esophageal replacement is associated with significant morbidity that may lead to operative interventions. This study reviews the management and outcome of children who underwent reoperation after esophageal replacement.
Methods:
Eighteen patients who underwent esophageal replacement from 1985 to 1997 were reviewed retrospectively. Ten patients underwent reoperation. Patient management, perioperative morbidity, and the dietary intake at follow-up were recorded for each patient.
Results:
Of the reoperated patients, 7 had esophageal atresia, 2 had caustic ingestion, and 1 had achalasia. Nine patients received a colon interposition, and 1 received a reverse gastric tube as the initial esophageal replacement. Seven patients required revision of the anastomoses. Three patients required complex esophageal reconstruction: 1 underwent gastric transposition, 1 underwent free jejunal graft, and 1 underwent gastric transposition combined with free jejunal graft. Seven patients were eating well at follow-up. Two patients still required partial gastrostomy tube feeding. One patient died 6 months postoperatively from aspiration pneumonia.
Conclusions:
Esophageal replacement continues to be a challenging operation associated with significant complications. Most reoperative procedures were directed toward strictures and persistent fistulae. Complete graft failure can be managed by gastric transposition or free jejunal graft. Despite the perioperative morbidity, most patients have good functional outcome.