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Esophageal replacement in children: 10 years' experience
Insights
Reversed gastric tube esophagoplasty is a viable option for pediatric esophageal replacement, offering advantages over colon interposition. This one-stage surgery resulted in no deaths and good long-term dietary function for children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Reconstruction
Background:
- Esophageal replacement remains a significant surgical challenge.
- Current methods include reversed gastric tube or colon interposition.
- Pediatric esophageal reconstruction requires careful consideration of technique and outcomes.
Purpose of the Study:
- To evaluate the efficacy and outcomes of one-stage esophageal reconstruction in children.
- To compare the use of reversed gastric tube versus colon interposition for esophageal replacement.
- To identify complications and long-term functional results of these procedures.
Main Methods:
- A retrospective review of 11 pediatric patients undergoing esophageal reconstruction between 1969 and 1978.
- Procedures included one-stage right colon interposition (seven patients) or reversed gastric tube (four patients).
- Patient ages ranged from 1 to 16 years, with follow-up at least six months post-surgery.
Main Results:
- No postoperative deaths occurred in either group.
- Common complications included temporary salivary fistula and cervical anastomotic stricture.
- All patients achieved a normal diet post-surgery, indicating successful functional restoration.
Conclusions:
- The reversed gastric tube technique avoids intestinal resection and preserves the ileocecal valve.
- It offers a shorter operative period and retains the option for colon interposition if needed.
- Based on this experience, reversed gastric tube is advocated for pediatric esophageal replacement.
Abstract:
Esophageal replacement continues to be a challenging surgical problem. Currently advocated methods entail using reversed gastric tube or colon for the interposition. Between 1969 and 1978, 11 children underwent esophageal reconstruction. Their ages at operation ranged from 1 to 16 years. All the operations were performed in one stage. The right colon was used in seven children and reversed gastric tube in four. There were no postoperative deaths. Temporary salivary fistula and cervical anastomotic stricture were the most common operation-related complications. On the follow-up visit, at least six months after surgery, all the children were able to eat a normal diet. The use of reversed gastric tube avoids intestinal resection, preserves the ileocecal valve, shortens the operative period and preserves the possibility of an alternative procedure (colon interposition) if technical failure occurs. On the basis of our limited experience we advocate the use of reversed gastric tube for esophageal replacement.