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Total gastric transposition: an alternative to esophageal replacement in children
W C Marujo1, U Tannuri, J G Maksoud
1Pediatric Surgery Division, University of São Paulo Medical School, Brazil.
Insights
Total gastric transposition is a safe surgical option for pediatric esophageal replacement, offering good functional outcomes with low morbidity and mortality. This procedure is a viable alternative for children requiring esophageal reconstruction.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Thoracic Surgery
Background:
- Esophageal replacement in children is a complex surgical challenge.
- Congenital esophageal anomalies often necessitate esophageal replacement.
- Total gastric transposition offers an alternative to traditional methods.
Purpose of the Study:
- To evaluate the safety and efficacy of total gastric transposition in children.
- To assess functional outcomes and complications associated with this procedure.
- To determine the long-term results of gastric transposition for esophageal replacement.
Main Methods:
- Total gastric transposition performed in 21 pediatric patients.
- Stomach transposition via esophageal bed or retrosternal route.
- Follow-up ranged from 10 to 122 months.
Main Results:
- Low mortality (1 early death) and manageable morbidity (cervical leaks, anastomotic strictures).
- Excellent (85%) and good (15%) functional outcomes achieved.
- No significant long-term respiratory issues or major weight concerns.
Conclusions:
- Total gastric transposition is a safe and effective alternative for pediatric esophageal replacement.
- The procedure demonstrates low morbidity and satisfactory functional results.
- This technique provides a valuable option for complex pediatric esophageal reconstruction.
Abstract:
Total gastric transposition was performed in 21 children as an alternative procedure for esophageal replacement. The age at the operation ranged from 15 months to 11 years. Half of the children were less than 2 years old. Fifteen patients had esophageal atresia. The stomach was passed toward the neck either through the esophageal bed (6 cases, with concomitant blunt esophagectomy without thoracotomy) or the retrosternal route (15 cases). There was one death in the early postoperative period secondary to an anastomotic leak and acute mediastinitis in a case of pharyngogastric anastomosis. Three other patients developed cervical leak with spontaneous closure but this ultimately led to a late anastomotic stricture (more than 6 months) requiring endoscopic dilatation. Only one child needed more than three attempts of endoscopic dilatation. None of these patients required surgical revision. The mean follow-up was 60 months (range, 10 to 122 months). Despite bulky atonic intrathoracic stomach occurring in some children, only two patients developed regurgitation and symptoms of poor gastric emptying. There were neither early nor late respiratory problems. Excellent and good functional outcome were achieved in 85% and 15% of the patients, respectively. Two patients have not undergone a weight catch-up phase. The majority of the children have been between the 20th and 80th percentile for weight. Five children remain below the 20th and two below the 5th percentile. The remarkably low morbidity and mortality combined with satisfactory functional results indicate that the total gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in children.