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Gastric tube oesophagoplasty--a long-term assessment
Insights
Gastric tube esophagoplasty is a safe and effective procedure for esophageal replacement in children, showing low mortality and excellent long-term outcomes. Substernal routing reduces serious chest complications compared to transthoracic approaches.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Techniques
Background:
- Gastric tube esophagoplasty is a surgical procedure for esophageal replacement.
- The Royal Alexandra Hospital for Children has extensive experience with this procedure since 1968.
Purpose of the Study:
- To present the long-term results of gastric tube esophagoplasty in children.
- To compare two different techniques of gastric tube esophagoplasty.
Main Methods:
- Retrospective review of 46 gastric tube esophagoplasty operations performed between 1968 and 1982.
- Comparison of substernal versus transthoracic gastric tube routing.
- Evaluation of early and long-term postoperative complications and outcomes.
Main Results:
- Gastric tube esophagoplasty demonstrated a very low mortality and failure rate.
- Substernal routing was associated with fewer serious chest complications, diaphragmatic herniation, and obstruction.
- Long-term results were highly encouraging, with most children leading active, normal lives.
- No significant difference in long-term outcomes between the two techniques was observed.
Conclusions:
- Gastric tube esophagoplasty is a highly satisfactory procedure for esophageal replacement in children.
- Substernal gastric tube routing is preferred due to a lower risk of chest complications.
- The procedure offers excellent long-term function without the late complications seen with colonic tubes.
Abstract:
The first gastric tube oesophagoplasty at the Royal Alexandra Hospital for Children was performed in 1968. Over the next 15 years, until 1982, a total of 46 operations were performed. This represents the largest series of gastric tube oesophagoplasty in children yet reported in the literature. Two techniques have been in use and are compared. The main aim of the paper is to present the long-term results of gastric tube oesophagoplasty. In our 15 years' experience with the gastric tube for oesophageal replacement, we have found it to be a very satisfactory procedure, with a very low mortality and failure rate. The vascularity of the stomach gives rise to less anxiety than with colon. Early postoperative complications are readily identified and treated. There is a higher risk of serious chest complications in bringing the gastric tube through the chest with primary anastomosis in the neck. This also predisposes to diaphragmatic herniation and obstruction, complications not seen when the gastric tube is brought up substernally. The long-term results are very encouraging, with virtually all the children leading active and normal lives. The gastric tube functions satisfactorily with no evidence of the late complications often reported with colonic tubes. There is no significant difference in the long-term results of the two techniques of gastric tube oesophagoplasty used in this hospital.