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Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special
Ronald B Hirschl1, Dani Yardeni, Keith Oldham
1C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan 48109-0245, USA. rhirschl@umich.edu
Insights
Gastric transposition is a safe and effective method for esophageal replacement in children, offering a durable solution with few complications. This procedure helps restore gastrointestinal continuity, enabling oral feeding and weight gain in most pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal replacement in children is typically for benign conditions requiring a long-lasting conduit (>70 years).
- Colon interpositions historically had high complication rates and conduit loss.
- Gastric transposition was adopted in 1985 as an alternative to colon for esophageal replacement in pediatric patients.
Purpose of the Study:
- To evaluate the authors' experience with gastric transposition for esophageal replacement in children.
- To assess the safety and efficacy of gastric transposition in pediatric patients with esophageal abnormalities.
Main Methods:
- Retrospective review of 41 pediatric patients undergoing gastric transposition for esophageal replacement.
- Indications included esophageal atresia, corrosive injury, leiomyomatosis, and refractory gastroesophageal reflux.
- Analysis of surgical outcomes, complications, and long-term functional results.
Main Results:
- Gastric transposition was performed in children aged 3.3 years on average, with a low complication rate and no mortality.
- Common complications included esophagogastric anastomotic leak (36%) and stricture formation (49%), which resolved or were manageable.
- Feeding intolerance occurred in 20% of patients, often related to underlying conditions or neurological impairment.
Conclusions:
- Gastric transposition effectively restores gastrointestinal continuity in children requiring esophageal replacement.
- The procedure is associated with few complications and facilitates oral feeding and weight gain.
- Gastric transposition is a suitable alternative for esophageal replacement in pediatric patients.
Objective:
To evaluate the authors' experience with gastric transposition as a method of esophageal replacement in children with congenital or acquired abnormalities of the esophagus.
Summary Background Data:
Esophageal replacement in children is almost always done for benign disease and thus requires a conduit that will last more than 70 years. The organ most commonly used in the past has been colon; however, most series have been fraught with major complications and conduit loss. For these reasons, in 1985 the authors switched from using colon interpositions to gastric transpositions for esophageal replacement in infants and children.
Methods:
The authors retrospectively reviewed the records of 41 patients with the diagnoses of esophageal atresia (n = 26), corrosive injury (n = 8), leiomyomatosis (n = 5), and refractory gastroesophageal reflux (n = 2) who underwent gastric transposition for esophageal replacement.
Results:
Mean +/- SE age at the time of gastric transposition was 3.3 +/- 0.6 years. All but two transpositions were performed through the posterior mediastinum without mortality or loss of the gastric conduit despite previous surgery on the gastric fundus in 8 (20%), previous esophageal operations in 15 (37%), and previous esophageal perforations in 6 (15%) patients. Complications included esophagogastric anastomotic leak (n = 15, 36%), which uniformly resolved without intervention; stricture formation (n = 20, 49%), all of which no longer require dilation; and feeding intolerance necessitating jejunal feeding (n = 8, 20%) due to delayed gastric emptying (n = 3), feeding aversion related to the underlying anomaly (n = 1), or severe neurological impairment (n = 4). No redo anastomoses were required.
Conclusions:
Gastric transposition reestablishes effective gastrointestinal continuity with few complications. Oral feeding and appropriate weight gain are achieved in most children. Therefore, gastric transposition is an appropriate alternative for esophageal replacement in infants and children.
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