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Gastric transposition for esophageal replacement in children--an Indian experience
Insights
Gastric transposition is a safe and effective esophageal replacement in children, offering good functional outcomes. This study highlights its viability in infants and young children, despite some manageable complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Pediatric surgeons often hesitate regarding gastric transposition for esophageal replacement in children, particularly infants.
- Esophageal atresia and corrosive strictures are primary indications for esophageal replacement in pediatric patients.
Purpose of the Study:
- To evaluate the initial experience and outcomes of gastric transposition for esophageal replacement in pediatric patients.
- To assess the safety, feasibility, and functional results of this procedure in infants and children.
Main Methods:
- A retrospective review of five pediatric patients who underwent gastric transposition for esophageal replacement.
- Patients included four infants with wide-gap esophageal atresia and one child with corrosive esophageal stricture.
- Surgical approaches included transhiatal and retrosternal routes, with gastric outlet drainage in all cases.
Main Results:
- The study involved five children (four infants) with a mean follow-up of 1.7 years.
- Complications included one mortality due to ventilation difficulties, anastomotic leak, adhesive obstruction, transient nerve palsies, and poor weight gain.
- Despite variable gastric emptying, no duodenogastric reflux was observed postoperatively.
Conclusions:
- Gastric transposition is a safe, relatively simple, and physiologic procedure for esophageal replacement in pediatric patients.
- The technique provides good functional results in infants and children, supporting its consideration in complex esophageal conditions.
Abstract:
Most pediatric surgeons are wary of gastric transposition as a means for esophageal replacement in children, especially during infancy. We present our initial experience of this technique in five children followed up for an average 1.7 years postoperatively. Four of them were infants (age range 5 m to 10 m at the time of transposition) with wide-gap esophageal atresia, while one was operated upon for an extensive corrosive esophageal stricture at 4 years age. The stomach was placed transhiatally in 3 patients and through the retrosternal route in 2 patients. A gastric outlet drainage procedure was performed in all cases. The average age at transposition in the 4 infants with esophageal atresia was 8.5 months and the mean weight was 7.4 kg. Three of the four infants required postoperative ventilation (mean duration 40 hours) and the average duration of hospital stay was 24 days. Our first transposition in a chubby infant resulted in death (20% mortality for this series) due to difficult ventilation. Other complications included anastomotic leak and subsequent stricture (one patient), adhesive obstruction (one patient), transient Horner's syndrome and recurrent laryngeal nerve palsy (one patient), and poor weight gain (one patient). Postoperatively, while the pattern of liquid gastric emptying was variable, no duodenogastric reflux was demonstrable. Thus gastric transposition is a safe, relatively simple and physiologic procedure in infancy and childhood and has given good functional results.