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Gastric transposition for esophageal substitution in children
1Hospital for Sick Children, London, England.
Insights
Gastric transposition is a viable esophageal substitution for various conditions, including esophageal atresia. This study shows a 9.2% mortality and 12.9% anastomotic leak rate, with good long-term outcomes in most patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal substitution is necessary for conditions like esophageal atresia and strictures.
- Gastric transposition is a surgical option for esophageal replacement.
- Previous attempts with colonic grafts were unsuccessful in some patients.
Purpose of the Study:
- To evaluate the outcomes of gastric transposition for esophageal substitution.
- To analyze complications and long-term results of the procedure.
Main Methods:
- A retrospective review of 54 gastric transposition procedures performed between 1981 and 1990.
- Indications included esophageal atresia, caustic strictures, and other esophageal anomalies.
- Posterior mediastinal transposition without thoracotomy was the preferred technique.
Main Results:
- Mortality rate was 9.2% (5 deaths).
- Anastomotic leak occurred in 12.9% (7 patients) but resolved spontaneously.
- Anastomotic stricture occurred in 5 patients, successfully treated with bouginage.
- Major complications affected 12 patients, requiring further interventions.
- Feeding problems were temporary in 12 children.
- Medium-term results were excellent in 67% and good in 20% of survivors.
Conclusions:
- Gastric transposition is an effective method for esophageal substitution in children and adolescents.
- The posterior mediastinal approach without thoracotomy is feasible.
- While complications exist, the overall results suggest a favorable outcome for this procedure.
Abstract:
Fifty-four gastric transposition procedures have been carried out for esophageal substitution in the 10-year period 1981 through 1990. The indication for esophageal replacement was esophageal atresia in 36 (19 long-gap atresia with distal fistula and 17 isolated atresia), caustic stricture in 9, intractable peptic reflux stricture in 3, 2 achalasia and 1 each of prolonged foreign body impaction, diffuse leiomyoma, congenital esophageal stenosis, and congenital short esophagus. Eight patients had previously undergone an unsuccessful colonic replacement procedure. The age at gastric transposition ranged from 4 months to 16 years. The procedure of choice was posterior mediastinal transposition without thoracotomy in 37 cases. The esophagogastric anastomosis leaked in 7 patients (12.9%), all of which closed spontaneously, whereas 5 patients developed an anastomotic stricture that responded to bouginage. There were 5 deaths (9.2%). Major complications developed postoperatively in 12 patients: 4 required additional gastric drainage procedures, 2 required temporary tracheostomy, 2 developed adhesion obstruction, and 1 each developed paraesophageal hernia, leakage of the jejunal feeding tube, tracheomalacia, and major hemorrhage following resection of a colonic graft. Major but temporary feeding problems were encountered in 12 children. Medium-term results were assessed as excellent in 67%, good in 20%, fair in 6%, and poor in 6% of the 34 patients surviving longer than 1 year postoperatively (ie, excluding 7 patients lost to follow-up).