Related Experiment Videos
Evaluation of lower esophageal sphincter function in infants and children following esophageal surgery
K Takano1, M Iwafuchi, M Uchiyama
1Department of Pediatric Surgery, Niigata University Hospital, Japan.
Insights
Surgical interventions for pediatric esophageal disorders can improve lower esophageal sphincter (LES) function and esophagocardiac motility. However, congenital issues like esophageal atresia may persist despite improved LES function after surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Esophageal disorders in children often involve lower esophageal sphincter (LES) dysfunction and abnormal esophagocardiac motility.
- Gastroesophageal reflux (GER) is frequently associated with hiatal hernias and can be exacerbated by LES abnormalities.
Purpose of the Study:
- To evaluate the impact of surgical interventions on LES function and esophagocardiac motility in pediatric patients with esophageal disorders.
- To assess the effectiveness of antireflux operations and specific procedures for esophageal atresia (EA) and esophageal varices.
Main Methods:
- Esophageal manometry was performed pre- and post-operatively in children undergoing surgery for conditions including EA, hiatal hernias with GER, and esophageal varices.
- Specific surgical techniques evaluated include antireflux operations, Livaditis' procedure for EA, and esophageal transection with vagotomy for varices.
Main Results:
- Antireflux operations improved LES pressure and length, and esophagocardiac motility in patients with hiatal hernias and GER.
- Abnormal esophageal waves in EA patients persisted post-operatively, suggesting a congenital etiology.
- Livaditis' procedure for EA and esophageal transection for varices preserved LES and esophagocardiac function, preventing GER.
Conclusions:
- Surgical interventions can effectively restore LES function and esophagocardiac motility in many pediatric esophageal disorders.
- Congenital abnormalities, such as those in EA, may underlie persistent motility issues despite surgical correction.
- Specific surgical approaches maintain esophageal function and prevent GER in complex pediatric esophageal conditions.
Abstract:
Esophageal manometry was performed before and after the operations for esophageal disorders in children to evaluate lower esophageal sphincter (LES) function and motility of the esophagocardiac region in each disease. Patients who underwent radical operations for gross C-type esophageal atresia (EA) and those with hiatal hernias considered to have gastroesophageal reflux (GER) showed reduction in LESP and LESL and eosphagocardiac motor abnormalities. Lower esophageal sphincter pressure and length, and motility of the esophagocardiac region improved in six patients who underwent an antireflux operation. Abnormal esophageal waves in EA patients persisted even after improvements in LES function by the antireflux operation and were considered to be a congenital problem, as the literature suggests. Effects of surgical intervention on the esophagus on the LES function were studied. Lower esophageal sphincter and esophagocardiac function were preserved, and GER did not develop after Livaditis' procedure for EA or esophageal transection and sectioning the esophageal branch of the vagus nerve for esophageal varices. Anatomic abnormalities that lead to LES dysfunction are considered to cause GER.