Oesophageal replacement in children.

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Oesophageal replacement in children is typically indicated for intractable corrosive strictures and long-gap oesophageal atresia.
• Paediatric surgeons aim to preserve the native oesophagus, resorting to conduit creation when dilatations fail.
• The ideal neo-oesophagus should enable normal feeding, prevent gastro-oesophageal reflux, and function lifelong.

Purpose of the Study:

• To review and discuss common oesophageal replacement conduits used in pediatric surgery.
• To analyze the available literature on the outcomes and complications of different oesophageal substitutes.

Main Methods:

• A Medline search was performed using keywords: oesophageal replacement, oesophageal atresia, gastric transposition, colon transposition, gastric tube, and caustic stricture.
• Commonly used conduits such as whole stomach, gastric tube, colon, and jejunum were discussed.

Main Results:

• No randomized controlled trials compare oesophageal conduits in children; technique choice is often based on preference and experience.
• Long-term outcome data are most robust for gastric transposition and colon replacement.
• Early complications include graft necrosis, anastomotic leaks, and sepsis. Late complications include strictures, poor feeding, reflux, tortuosity, and Barrett's oesophagus. Larger series report fewer complications, likely due to accumulated experience.

Conclusions:

• Long-term follow-up is essential for children undergoing oesophageal replacement.
• Monitoring is necessary due to the risk of late strictures, neo-oesophageal tortuosity, and the development of Barrett's oesophagus.