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Caustic esophageal strictures in children: 30 years' experience
Alaa F Hamza1, Sameh Abdelhay, Hatem Sherif
1Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Journal of Pediatric Surgery
|June 5, 2003
Summary
Esophageal replacement using colon is ideal for children with caustic injuries when dilatation fails. The posterior mediastinal route offers better long-term results than the retrosternal approach.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Caustic esophageal injuries are common in children in developing countries.
- Dilatation is the initial treatment, but success rates range from 60% to 80%.
Purpose of the Study:
- To evaluate the outcomes of different esophageal replacement techniques in pediatric patients.
- To compare the retrosternal and posterior mediastinal colon replacement routes.
Main Methods:
- Retrospective review of 850 esophageal replacement cases over 30 years.
- Analysis of three techniques: gastric pull-up, retrosternal colon, and transhiatal posterior mediastinal colon replacement.
- Complication assessment in the last 475 cases.
Main Results:
- Posterior mediastinal colon replacement (225 cases) showed lower complication rates compared to retrosternal (550 cases).
- Complications included cervical leakage (10%), proximal strictures (5%), obstruction (2%), mortality (1%), and graft stenosis (0.6%).
- The posterior mediastinal route demonstrated improved evacuation and reduced reflux in long-term follow-up.
Conclusions:
- Colonic esophageal replacement is the preferred treatment after dilatation failure for caustic esophageal strictures.
- The posterior mediastinal route is advantageous due to its shorter approach and superior long-term functional outcomes.