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[Artificial esophagus in children]
Insights
This study refines coloesophagoplasty (CEP) principles and evaluates outcomes in pediatric esophageal atresia and pharyngeal stenosis patients. Improved CEP techniques significantly reduced complications and mortality, enhancing long-term quality of life.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Context:
- Esophageal atresia and pharyngeal stenosis are critical pediatric conditions requiring surgical intervention.
- Coloesophagoplasty (CEP) is a reconstructive procedure for esophageal replacement.
- Over 50 years, extensive experience has been gained in pediatric esophageal surgeries, including over 600 artificial esophagus creations.
Purpose:
- To formulate updated principles for coloesophagoplasty (CEP) and compare different CEP methods.
- To determine the optimal age for esophagoplasty in children with esophageal atresia.
- To evaluate the quality of life and long-term results following childhood esophagoplasty.
- To present surgical treatment outcomes for pediatric pharyngeal stenosis.
Summary:
- The study analyzed 54 children (3 months-15 years) comparing retrosternal and posterior mediastinal esophagoplasty techniques.
- Optimal age for coloesophagoplasty in esophageal atresia was determined using data from 27 patients.
- Quality of life was assessed via questionnaires.
- Surgical treatment for pharyngeal stenosis, including pharyngoplasty with free intestinal transplants, was detailed, with 28 patients operated since 1980.
Impact:
- Updated CEP principles and clinical application reduced complications and lethality from 3% to 0.5%.
- Introduction of antireflux cologastroanastomosis decreased reflux-related complications.
- Esophagectomy is validated for various conditions including stenosis, Barrett's metaplasia, tumors, and portal hypertension.
Abstract:
The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.