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Fourteen years of gastric tubes
Insights
Gastric tube esophagoplasty is a successful esophageal replacement in children, despite common complications like leakage and strictures. Long-term outcomes remain satisfactory for patients requiring esophageal reconstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Reconstruction
Background:
- Esophageal replacement in infants and children has been performed using gastric tube procedures since 1964.
- This study updates a long-term series of gastric tube esophagoplasty, including follow-up data for up to 10 years.
Purpose of the Study:
- To review the outcomes of gastric tube esophagoplasty in a pediatric population.
- To evaluate the efficacy and complications of this esophageal replacement technique over an extended follow-up period.
Main Methods:
- A retrospective review of 30 pediatric patients who underwent gastric tube esophagoplasty.
- The primary method described is a two-stage, proximally based, reversed antiperistaltic gastric tube placed retrosternally.
- Analysis of complications, including leakage and anastomotic strictures, and long-term outcomes.
Main Results:
- Leakage at the esophagogastric anastomosis was the most common complication (63%), typically resolving spontaneously.
- Anastomotic stricture requiring dilatations occurred in 43% of cases.
- Mild sacculation or tortuosity of the gastric tube was rare.
Conclusions:
- Despite complications such as leakage and strictures, gastric tube esophagoplasty provides a satisfactory long-term outcome for children needing esophageal replacement.
- The retrosternal, two-stage gastric tube procedure remains a viable option for esophageal reconstruction in pediatric patients.
Abstract:
Since 1964 gastric tube replacement of the esophagus has been done in 30 infants and children. This report reviews and brings up to date our entire series, which includes follow-up of 15 children over 5 yr, 7 of whom have been followed for more than 10 yr. The two-stage proximally based reversed antiperistaltic gastric tube placed retrosternally is still our procedure of choice, although since our last report in 1973 several other methods (one-stage, transthoracic, subcutaneous) have been used, and the spleen has not been removed in our more recent operations. Whether the esophagogastric tube anastomosis is primary or secondary or is in the chest or neck, leakage is still the most common complication (63%), with all but three closing spontenously. A continuing problem may be an anastomotic stricture (43%) that will require some dilatations. Mild sacculation or tortuosity of the gastric tube has been encountered only once. Despite the above problems, the eventual outcome in the growing child with a gastric tube replacement continues to be a satsifying one. We continue to use the gastric tube operation when replacement of the esophagus is required.