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Esophageal replacement in children: experience with thirty-one cases
Insights
Esophageal replacement surgery in children, including colon or gastric tubes, is generally safe with no deaths in this series. Adding a gastric drainage procedure can reduce long-term issues like aspiration and ulcers.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal replacement in adults carries high risks.
- Pediatric esophageal replacement data is limited.
- Congenital anomalies and acquired conditions necessitate esophageal reconstruction in children.
Purpose of the Study:
- To evaluate the outcomes of esophageal replacement procedures in children.
- To identify complications and long-term morbidities associated with these surgeries.
- To assess the impact of adjunctive gastric drainage procedures.
Main Methods:
- Retrospective review of 31 pediatric patients undergoing esophageal replacement between 1970 and 1985.
- Procedures included right colon isoperistaltic segments, left colon antiperistaltic interposition, and gastric tube.
- Analysis of immediate and long-term complications, including anastomotic leaks, pulmonary issues, and peptic ulcer disease.
Main Results:
- No operative deaths were observed in the series.
- Common immediate complications included atelectasis and pneumothorax.
- Long-term issues comprised cervical anastomotic leaks, recurrent aspiration, and peptic ulceration in some patients.
- Patients with initial gastric drainage procedures showed no ulcer disease or aspiration pneumonitis.
Conclusions:
- Esophageal replacement procedures are relatively well-tolerated in children.
- Gastric drainage procedures are crucial for minimizing long-term morbidity, particularly aspiration and ulcer disease.
- Long-term follow-up is essential due to potential complications like reflux, peptic ulceration, and pulmonary issues.
Abstract:
Esophageal replacement procedures in adults are often performed for malignancy and are associated with significant morbidity and death. This article describes 31 children who underwent esophageal replacement procedures between 1970 and 1985. Diagnosis in the 18 boys and 13 girls included esophageal atresia in 23, caustic ingestion in six, and distal esophageal stricture caused by reflux in two. Replacement procedures performed included right colon isoperistaltic segments in 23 children, left colon antiperistaltic interposition in two, and gastric tube in four. Immediate complications included atelectasis (20), pneumothorax (four), and ventilator support greater than 2 days (eight). Ten patients developed leaks at the cervical anastomosis and required subsequent dilation. Seven patients had pulmonary restrictive disease caused by recurrent aspiration despite compliance with anti reflux measures. Four of these same children developed peptic ulceration before pyloroplasty. No patient who had a gastric drainage procedure as part of the initial operation has developed ulcer disease or aspiration pneumonitis. These data suggest that esophageal replacement procedures are relatively well tolerated in children with no deaths observed in this series. A gastric drainage procedure is an important adjunct in minimizing long-term morbidity. Since reflux, peptic ulceration, and pulmonary complications may occur, long-term follow-up essential.