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One-stage esophagectomy and in situ colon interposition for esophageal replacement in children
1Department of Surgery, Children's Hospital and Health Center, San Diego, CA, USA.
Insights
One-stage esophagectomy with in situ colon interposition offers excellent immediate and long-term results for pediatric esophageal replacement. This effective technique ensures normal growth and development in children requiring esophageal reconstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Esophageal replacement is crucial for benign pediatric esophageal strictures.
- Various methods exist, but long-term functional outcomes are paramount.
- One-stage esophagectomy and colon interposition is a viable option.
Purpose of the Study:
- To evaluate the immediate and long-term functional results of one-stage esophagectomy and in situ colon interposition in children.
- To assess the safety and efficacy of this esophageal replacement technique.
Main Methods:
- Seven children underwent one-stage esophagectomy and in situ colon interposition.
- The transverse colon was isolated and tunneled through the esophageal bed.
- Antireflux procedures included gastric wrapping and pyloroplasty.
Main Results:
- No postoperative morbidity or mortality was observed.
- Excellent functional swallowing and no anastomotic complications were reported.
- Normal growth and development were maintained up to 7 years postoperatively.
Conclusions:
- One-stage esophagectomy with in situ colon interposition is an excellent esophageal replacement technique for children.
- The procedure demonstrates promising safety and efficacy for pediatric esophageal strictures.
- Further long-term follow-up is warranted to confirm these findings.
Purpose:
Esophageal replacement has been achieved using stomach, gastric tube, small intestine, and colon in various positions and in single or multiple stages. Long-term functional results are of prime importance in children with benign disease. The aim of this study is to present the immediate and long-term results of one-stage esophagectomy and in situ colon interposition esophageal replacement in children.
Methods:
Seven children have undergone one-stage esophagectomy and in situ colon interposition esophageal replacement for stricture secondary to caustic ingestion (n = 4), battery ingestion (n = 2), and epidermolysis bullosa (n = 1).
Technique:
Via thoracoabdominal and cervical incisions, the transverse colon, isolated on the left colic artery, is pulled through the esophageal hiatus and normal esophageal bed into the neck at the time of simultaneous esophagectomy. The stomach is partially wrapped around the colon as an antireflux procedure and a pyloroplasty are performed.
Results:
There was no immediate postoperative morbidity or mortality. All patients were discharged taking a soft diet by mouth. There were no anastomotic leaks or strictures, and functional swallowing is excellent. Contrast studies show no dilation of the colon in the chest. Growth and development have been normal up to 7 years postoperatively.
Conclusion:
The one-stage esophagectomy and in situ colon interposition is an excellent technique for esophageal replacement in children. Continued evaluation of this technique will be necessary to confirm these preliminary results.