Challenges in Pediatric Foregut Replacements: An 11-Year Single-Center Experience

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Reconstruction

Background:

• Foregut replacements are performed in pediatric patients for conditions including esophageal atresia, refractory strictures, caustic injuries, and malignancy.
• Advances in esophageal atresia management and GERD treatment have reduced the need for these procedures.
• Despite declining rates, pediatric surgeons must remain prepared for complex foregut replacement surgeries.

Purpose of the Study:

• To describe the outcomes of 10 pediatric foregut replacement surgeries performed over an 11-year period.
• To identify the primary indications for foregut replacement in the pediatric population.
• To evaluate the types of reconstruction used and associated early and late complications.

Main Methods:

• A retrospective review of case logs from a pediatric surgeon at an academic medical center (December 2013 - December 2024).
• Inclusion criteria: pediatric patients undergoing "esophagectomy", "esophageal replacement", "ileocolonic interposition", or "gastric pull-up".
• Review of patient charts and operative reports to gather data on indications, procedures, and complications.

Main Results:

• Ten pediatric patients (8 months - 23 years) underwent foregut replacement; 60% were female and 80% Hispanic.
• Leading indications were esophageal atresia and caustic injury.
• Ileocolonic conduits were the most frequent reconstruction (60%). Early complications included anastomotic leaks (50%) and infections (30%). Late complications included dysphagia (70%) and stricture formation (50%).

Conclusions:

• Foregut replacement remains a necessary, albeit infrequent, procedure for specific pediatric pathologies.
• Ileocolonic interposition was the predominant reconstruction method in this series.
• Late complications, particularly dysphagia and strictures, are common, highlighting the importance of surgical expertise and careful patient selection.