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Intestinal bypass of the esophagus

J G Raffensperger1, S R Luck, M Reynolds

  • 1Division of Pediatric Surgery, Children's Memorial Hospital, Chicago, IL., USA.

Journal of Pediatric Surgery
|January 1, 1996
PubMed
Summary

Esophageal replacement using intestinal segments provides long-term swallowing function for children. Ileocolic segments are preferred, with good outcomes despite some complications like leaks and strictures.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Reconstruction

Background:

  • Esophageal atresia and acquired strictures necessitate esophageal replacement in children.
  • Various intestinal segments, including ileum, cecum, and colon, have been utilized for esophageal reconstruction.
  • Long-term functional outcomes and complication rates of different esophageal replacement techniques require evaluation.

Purpose of the Study:

  • To evaluate the long-term outcomes of esophageal replacement in children using intestinal segments.
  • To compare the efficacy and safety of different intestinal segments for esophageal reconstruction.
  • To identify factors influencing functional swallowing and complication rates.

Main Methods:

  • Retrospective review of 63 children undergoing esophageal bypass or resection and replacement.
  • Follow-up periods ranging from 1 to 37 years, with 36 cases exceeding 5 years.
  • Analysis of complications including leaks, strictures, necrosis, and adhesive obstruction.

Main Results:

  • A retrosternal isoperistaltic ileocolic segment was the preferred method in 48 patients with good outcomes.
  • Cervical anastomotic leaks occurred in 11 children, and strictures in 13, with higher rates in caustic burn patients.
  • 43 of 61 survivors had no swallowing difficulties; 17 experienced mild dysphagia.
  • Patients with esophageal atresia showed poorer growth compared to those with acquired conditions.

Conclusions:

  • Isoperistaltic ileocolic intestinal segments are effective for esophageal replacement in children, offering near-normal swallowing.
  • While complications like leaks and strictures can occur, reoperation and alternative interpositions lead to successful reconstruction.
  • Esophageal replacement provides a viable solution for pediatric esophageal defects, though growth may be affected in congenital cases.

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