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[Surgical reconstruction of long esophageal stenoses in children]
1Oddĕlení dĕtské chirurgie FN KUNZ katedry pediatrie, porodonictví a gynekologie.
Insights
This study details four pediatric cases of long esophageal stenosis, exploring surgical repair options. Techniques like myotomy and colonic replacement offer effective treatment for severe esophageal strictures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Diseases
Background:
- Long esophageal stenosis in children presents complex surgical challenges.
- Etiologies include fibromuscular issues, achalasia, chemical injury (sulfuric acid etching), and tumors.
- Effective management requires tailored surgical approaches based on stenosis characteristics.
Observation:
- Four pediatric cases of long esophageal stenosis were analyzed.
- Surgical interventions included extramucous myotomy, esophagotomy, and colonic replacement.
- The choice of procedure depended on the function of the stenotic esophageal segment.
Findings:
- Esophageal stenosis is repairable via esophagomyotomy or esophagotomy if the stenotic segment retains function.
- Preventing complications like fistula, diverticulum, reflux, and restenosis is crucial.
- Gastric fundus patch covering and fundoplication are recommended to mitigate postoperative issues.
- Extensive anatomical and functional esophageal wall damage necessitates esophagoplasty and intestinal interposition.
Implications:
- Surgical repair of long esophageal stenosis in children is feasible with various techniques.
- Preventive measures against postoperative complications are vital for successful outcomes.
- Complex cases may require multi-stage reconstructive procedures like intestinal interposition.
Abstract:
Four cases related with the long stenosis of lower part of esophagus are referred to in children. These were stenoses of fibromuscular type, due to achalasia and resulting from etching with sulphuric acid as well as from tumor. The extramucous myotomy, esophagotomy and colonic replacement of long esophageal stenosis were elected. The condition is repairable by esophagomyotomy or esophagotomy when the function of stenotic portion of esophagus is preserved. To prevent postoperative complications such as fistula, diverticulum, gastroesophageal reflux and restenosis, the covering of incision with a patch from gastric fundus is recommended with subsequent fundoplication. Anatomical and functional lesion of esophageal wall in the presence of long stenosis requires its esophagoplasty as well as replacement with the intestinal interposition.