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Updated: Aug 7, 2026
Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Challenges in Pediatric Foregut Replacements: An 11-Year Single-Center Experience
Susana Fortich1, Jana E DeJesus1, Esther Ewing1
1Department of Surgery, University of Texas Medical Branch, Galveston, USA.
Insights
Pediatric foregut replacements, though rare, are necessary for conditions like esophageal atresia. Ileocolonic conduits were most common, with late complications like dysphagia being frequent in this 10-patient series.
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.
Abstract:
Introduction Foregut replacements are performed in the pediatric population for esophageal atresia, long-segment strictures resistant to repeated dilations, caustic injuries, and malignancy. The need for foregut replacements has declined due to advances in the management of esophageal atresia and GERD (gastroesophageal reflux disease), as well as protective devices on caustic chemical containers. However, given the technical challenges of these procedures, pediatric and general surgeons should be prepared in case a foregut replacement is required. This case series describes 10 foregut replacements performed between 2013 and 2024. Methods Case logs of a pediatric surgeon at an academic medical center were reviewed between December 2013 and December 2024. Cases involving "esophagectomy", "esophageal replacement", "ileocolonic interposition", and "gastric pull-up" were included. Patient charts and operative reports were reviewed. Results A total of 10 pediatric patients (aged eight months to 23 years) underwent foregut replacement. Most patients were female (n = 6, 60%) and Hispanic (n = 8, 80%). Esophageal atresia and caustic injury were the leading indications for surgery. Ileocolonic conduits were the most commonly used reconstruction method (n = 6, 60%). Early complications included anastomotic leaks (n = 5, 50%), infections (n = 3, 30%), and dumping syndrome (n = 1, 10%). Late complications included dysphagia (n = 7, 70%), stricture formation (n = 5, 50%), and GERD (n = 4, 40%). Conclusion Though infrequently performed, foregut replacements in the pediatric population are still required in certain pathologic cases. Our series examined 10 patients who underwent replacement over 11 years. Ileocolonic conduits were the most frequently performed reconstruction, and late complications were more common. Understanding the patient's clinical history and knowledge of conduit and route options are important for proper management.
