Ileocolic replacement of esophagus in children with esophageal stricture

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Otolaryngology

Background:

• Esophageal strictures in children often result from caustic ingestion.
• Esophageal dilation therapy can be ineffective for severe strictures.
• Restrosternal esophageal substitution is a surgical option for complex cases.

Purpose of the Study:

• To evaluate the efficacy and outcomes of ileocolic interposition for esophageal substitution in pediatric patients.
• To assess the long-term results of this surgical technique in children with severe esophageal strictures.

Main Methods:

• A retrospective review of 12 pediatric patients undergoing restrosternal esophageal substitution with an ileocolic segment between 1970 and 1988.
• Patients aged 2–6 years with esophageal strictures secondary to caustic ingestion, who failed dilation therapy.

Main Results:

• 11 of 12 surviving patients achieved a normal diet and normal growth and development.
• One perioperative death occurred due to cardiac arrest.
• Early complications included three cervical anastomotic leaks (spontaneous healing) and one late gastrointestinal bleed (managed conservatively).
• Three cases of ileocolic segment redundancy were noted.

Conclusions:

• Ileocolic interposition is a successful treatment for pediatric esophageal strictures unresponsive to dilation.
• The procedure facilitates normal eating, growth, and development in the majority of surviving patients.
• While complications can occur, long-term outcomes are generally favorable.