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Colonic replacement for the treatment of caustic esophageal strictures in children
H Z Gündoğdu1, F C Tanyel, N Büyükpamukçu
1Department of Pediatric Surgery Hacettepe University Children's Hospital, Ankara, Turkey.
Insights
Colonic esophageal replacement effectively treats pediatric caustic strictures, with 92% of patients achieving normal eating function. This procedure offers a successful alternative for children requiring esophageal substitution.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Reconstruction
Background:
- Caustic esophageal strictures are a common reason for esophageal replacement in children.
- These strictures often result from accidental ingestion of corrosive substances.
Purpose of the Study:
- To evaluate the indications and outcomes of colonic interposition for caustic esophageal strictures in pediatric patients.
- To assess the long-term efficacy and safety of this surgical technique.
Main Methods:
- A retrospective review of 50 pediatric patients who underwent colonic esophageal replacement between 1976 and 1989.
- Analysis of patient demographics, indications for surgery, surgical technique (right vs. left colon), and follow-up data.
Main Results:
- Indications included severe lumen obliteration (42%), post-dilation difficulties (32%), and bleeding/perforation during dilation (26%).
- Excellent growth was observed in 49 out of 50 patients.
- 92% of patients experienced good outcomes with the ability to eat normally; 6% had occasional dysphagia requiring dilation.
Conclusions:
- Colonic interposition is a safe and effective method for esophageal replacement in children with caustic strictures.
- It provides an excellent substitute for the native esophagus, leading to good functional outcomes and growth.
Abstract:
Caustic esophageal stricture is one of the most common indications for esophageal replacement in children. During a 13-year period between 1976 and 1989, colonic replacement was performed in 50 patients for the treatment of caustic esophageal strictures at the Department of Pediatric Surgery of Hacettepe University Children's Hospital. A retrospective clinical study was undertaken to discuss the indications and results of colonic replacement. The 50 children, 34 of whom were male (68%) and 16 of whom were female (32%) with 27 patients (54%) under 6 years of age, were evaluated retrospectively. Indications for operation included 21 (42%) who could not swallow saliva and had total or nearly total obliteration of lumen involving more than 3 cm of an esophageal segment at admittance, and 16 (32%) who had difficulty in swallowing within a 1-month period following the last dilation after completion of a 1-year dilation program. A further 13 (26%) had bleeding and difficulties during dilations, after experiencing an esophageal perforation. The right colon was used in 48 and the left in the remaining 2 patients. Patients were followed for at least 1 year following replacement. Growth was excellent in all but one patient who had redundant colon and showed growth retardation. There was one postoperative late death because of massive bleeding from ulceration of the transplanted colon. The other 49 patients were available for accurate follow-up. The results were good, 46 (92%) were able to eat everything, while occasional dysphagia in 3 (6%) required dilation after operation. Colon conduit provides an excellent substitute for esophagus in pediatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)