Transhiatal esophagectomy and colonic interposition for caustic esophageal stricture
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1Department of Surgery, Ain Shams University, School of Medicine, Cairo, Egypt.
Insights
This study shows that transhiatal esophagectomy with colonic interposition is a safe and effective treatment for children with caustic esophageal strictures, offering good long-term results.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Caustic ingestion in children can lead to severe esophageal strictures.
- Esophageal replacement is often necessary for these strictures.
- The transhiatal approach offers a minimally invasive option for esophageal surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of simultaneous esophagectomy and colonic interposition using the transhiatal approach in children with caustic esophageal strictures.
- To assess long-term functional outcomes and complications associated with this surgical technique.
Main Methods:
- A retrospective review of 70 children who underwent transhiatal esophagectomy and colonic interposition between 1986 and 1990.
- Utilized isoperistaltic left colon grafts based on left colic vessels.
- Employed end-to-side esophagocolic anastomosis and routine pyloroplasty.
Main Results:
- Low morbidity and satisfactory long-term functional results were observed.
- All colonic grafts survived, with a low incidence of postoperative leak (2%) and late stenosis (1%).
- Techniques to minimize graft redundancy and prevent reflux/ulceration were effective.
Conclusions:
- Transhiatal esophagectomy with colonic interposition is a viable and effective surgical option for pediatric caustic esophageal strictures.
- Specific surgical techniques, including graft selection and anastomosis type, contribute to favorable outcomes.
- This approach offers a safe alternative with good functional results and low complication rates.
Abstract:
From January 1986 through 1990, 70 children (42 boys, 28 girls) with esophageal stricture resulting from ingestion of caustic potash underwent simultaneous esophagectomy and colonic interposition utilizing the transhiatal esophageal approach. At the time of the procedure, their ages ranged from 14 months to 6 years (mean, 3.2 years). Thoracotomy was needed in one patient due to accidental injury to the tracheal during esophageal mobilization. There were 3 deaths from respiratory failure. Otherwise, morbidity was low, and there were satisfactory long-term functional results. The use of isoperistaltic left colon based on both ascending and descending branches of the left colic vessels resulted in survival of all grafts. End-to-side esophagocolic anastomosis decreased the incidence of both postoperative leak (2 instances) and late stenosis (1 case needed surgical revision). Construction of a length of colonic graft equal to the gap between the esophagus above the stricture and the stomach and fixation of the graft to the edge of the esophageal hiatus reduced the incidence of late colonic redundancy in the chest; this did occur in 4 cases but was not associated with dysphagia. Routine pyloroplasty and anterior cologastric anastomosis to the gastric antrum contributed to the absence of gastrocolic reflux and peptic ulceration in this series.