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Transhiatal esophagectomy in children with corrosive esophageal stricture
V O Adegboye1, A Brimmo, O A Adebo
1Department of Surgery, University College Hospital, Ibadan, Nigeria.
Insights
Transhiatal esophagectomy (THE) with stomach transposition safely treats corrosive esophageal strictures in children. While complications occurred, they responded well to treatment, with no mortality observed.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Corrosive esophageal strictures pose a significant challenge in pediatric patients, often necessitating complex surgical interventions.
- Esophageal replacement is a critical procedure for restoring swallowing function and improving quality of life.
Purpose of the Study:
- To evaluate the safety and efficacy of transhiatal esophagectomy (THE) with immediate isoperistaltic stomach transposition for corrosive esophageal strictures in children.
- To assess the postoperative outcomes and complication rates associated with this surgical approach.
Main Methods:
- Ten pediatric patients (ages 2-6 years) with corrosive esophageal strictures underwent THE and posterior mediastinal stomach transposition.
- Cervical esophagogastrostomy was performed without gastric drainage procedures. Management included nasogastric tubes, cervical drains, trans-oral irrigation for leaks, and jejunostomy feeding.
- Postoperative mechanical ventilation was elective (24-60 hours).
Main Results:
- The most common complication was pleural effusion (60%), followed by cervical anastomotic leaks (20%) and strictures (30%).
- Hoarseness was associated with anastomotic leaks and strictures in 20% of patients.
- All complications were managed effectively with appropriate treatment, and there was no operative mortality.
Conclusions:
- Transhiatal esophagectomy with isoperistaltic stomach transposition is a safe and effective procedure for pediatric corrosive esophageal strictures.
- Despite a high incidence of complications, the approach demonstrates favorable outcomes and is a viable surgical option.
Abstract:
Ten children with corrosive esophageal strictures were referred for esophageal replacement. The children whose ages ranged between 2 and 6 years (mean 4.1 +/- 1.4 years) had transhiatal esophagectomy (THE) and immediate posterior mediastinal transposition of their isoperistaltic stomach and cervical esophagogastrostomy. No patient had a gastric drainage procedure. All patients had nasogastric tube and a cervical perianastomotic drain until full oral intake resumed. Anastomotic leakages were managed by trans-oral irrigation (TOI) and postoperative feeding was through jejunostomy. Postoperative elective mechanical ventilation was for between 24 and 60 hours. Pleural entries were the commonest complication and they occurred in 6 patients (60%), unilateral in 2 patients, bilateral in 4 patients. Cervical anastomotic leaks and strictures occurred in 2 patients (20%) and 3 patients (30%), respectively, and the 2 patients (20%) who had anastomotic leaks and stricture had associated hoarseness. Though the incidence of complications was high, these responded well to appropriate treatment. There was no mortality in the series. THE and esophageal replacement with isoperistaltic stomach in the posterior mediastinum is a safe and useful procedure in the management of corrosive esophageal stricture in children.