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Gastric-tube esophagoplasty in children
1Department of Surgery, Division of Pediatric Surgery, Escola Paulista de Medicina, Federal University of the State of São Paulo and Hospital Infantil Menino Jesus, São Paulo, Brazil.
Insights
This study evaluated gastric-tube esophagoplasty in 19 children, finding that most achieved normal swallowing of solid food. Complications like fistulas and stenoses were manageable, with isoperistaltic gastric tubes preferred for esophageal replacement.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal reconstruction in children is crucial for treating conditions like esophageal atresia and stenosis.
- Gastric-tube esophagoplasty is a reconstructive technique used for esophageal replacement.
- Long-term outcomes and complication rates of this procedure in pediatric populations require thorough evaluation.
Purpose of the Study:
- To assess the efficacy and complications of gastric-tube esophagoplasty in pediatric patients.
- To evaluate the long-term functional outcomes, including swallowing ability and nutritional status.
- To compare the outcomes of isoperistaltic versus anisoperistaltic gastric tube techniques.
Main Methods:
- A retrospective review of 19 pediatric patients who underwent gastric-tube esophagoplasty between 1979 and 1996.
- Analysis of surgical techniques, including the use of isoperistaltic and anisoperistaltic gastric tubes and surgical approaches (retrosternal, posterior mediastinum, transpleural).
- Evaluation of complications such as cervical anastomosis fistulas, stenoses, and graft necrosis, along with their management and long-term follow-up (1-16 years).
Main Results:
- Out of 19 patients, 18 survived the surgery. The primary indications were esophageal atresia (14), caustic stenosis (3), and reflux-related stenosis (1).
- Common complications included cervical anastomosis fistulas (63.3%) and stenoses (42.1%), which were mostly managed conservatively or with endoscopic dilatation.
- Despite initial complications, all surviving patients could swallow solid food normally at long-term follow-up, with 77.7% achieving normal nutritional status.
Conclusions:
- Isoperistaltic gastric tube esophagoplasty is an effective method for esophageal replacement in children, with good long-term functional outcomes.
- While complications like fistulas and stenoses can occur, they are generally manageable and do not preclude normal swallowing.
- Optimal surgical timing and pre-operative nutritional status are essential for successful outcomes in pediatric esophageal reconstruction.
Abstract:
From 1979 to 1996, 19 patients underwent gastric-tube esophagoplasty. There were 10 boys and 9 girls, aged between 1 year 4 months and 4 years 11 months at the time of surgery. In 1 patient the esophagoplasty was performed due to a long stenosis secondary to reflux; 3 others had caustic stenoses; and the remaining patients had esophageal atresia. In 17 cases an isoperistaltic gastric tube was brought up to the neck through the retrosternal space; in 2 an anisoperistaltic gastric tube was used, cervical mobilization being via the posterior mediastinum without a thoracotomy in 1 case and by the left transpleural route in the other. The cervical anastomosis was carried out in one surgical stage in 12 patients and in two stages in 7. In 1 patient the tube was resected due to necrosis of its proximal third; the child later underwent an esophagocoloplasty. Necrosis of the colic graft, mediastinitis, and septicemia occurred, leading to the only death in the series. There were 12 fistulas of the cervical anastomosis (63.3%) and 8 stenoses (42.1%). All fistulas, with 1 exception, closed spontaneously after 8 days to 2 months, and all stenoses were treated by endoscopic dilatation. Another patient developed a fistula of the gastric tube with chronic evolution to a stenosis of the distal third of the tube and communication with the right lower pulmonary lobe. A lobectomy and closure of the fistula were necessary. All patients were followed for a period of 1 to 16 years. At present, all of them swallow solid food normally. The evolution of the nutritional status was normal (eutrophic) in 14 of the 18 patients (77.7%) who survived the operation; 4 showed variable degrees of malnutrition. In 2 of these 4 cases the malnutrition was due to poor socioeconomic conditions, but was not related to the surgery. Redundancy, a problem associated with esophagocoloplasty, was not observed in any of the gastric tubes, which was attributed to the thickness of the gastric wall. The authors prefer the use of an isoperistaltic gastric tube (with proximal base) for esophageal replacement in children and recommend that the operation should be carried out when the child is able to swallow solid foods and walk. As in any other major surgical procedure, a good nutritional state is essential prior to operation.