Esophageal Replacement in Children: A 10-Year, Single-Center Experience

Abstract

Objective: Various esophageal replacement grafts have been used in children, although none can equal the native esophagus. The purpose of this study was to review the complications and outcomes associated with using different techniques in a single institute. Methods: A retrospective medical record review was conducted from 2006 to 2016. Patient demographics, perioperative clinical courses, complications and long-term outcomes were reported as percentages and categorized according to the surgical procedure performed. Results: A total of 15 children underwent esophageal replacement procedures, comprising 7 (47%) isoperistaltic gastric tubes, 3 (20%) colonic interpositions, 3 (20%) gastric transpositions and 2 (13%) reversed gastric tubes. Indications for esophageal replacement included long-gap esophageal atresia (5; 33%), esophageal atresia with severe postoperative complications (6; 40%), and caustic injury (4; 27%).The mean age of patients was 2.9 years (range: 0.2-15 years). The average follow-up duration was 3.6 years (range: 0.4-8 years). There was no perioperative mortality and no graft loss in any group. The long-term outcomes were acceptable, with no late stricture. Eightysix percent of the patients in the isoperistaltic gastric tube group and all patients in the other procedural groups achieved full oral feeding. Nevertheless, the patients had various degrees of malnutrition. Conclusion: Esophageal replacement remains a major challenge in children. Our experience indicates that children can be safely operated on using any of these methods, with acceptable outcomes and no deaths. Nevertheless, the long-term consequences and complications should be monitored throughout adulthood.

The The Colon Interposition as Esophageal Replacement in Long-Gap Esophageal Atresia

“…3 A study by Laohapensang in 2019 revealed 3 patients who underwent colonic interposition and all three had anastomotic stenosis (100%) but all resolved after endoscopic dilatation. 11 Same stenosis problem was seen on our patient, but patient will be monitored in every follow-up examinations. Further action, such as endoscopic dilatation, will be considered, if the problem persists.…”

“…According to Laohapensang's report, three patients who underwent colonic interposition had admission period ranged between 20 and 55 days, with intensive care period between 4 and 14 days. 11 In case of long term complications, dysphagia symptoms were noted in 4 studies from Stefano's systematic review in 2017. 12 According to a long-term quality of life study conducted by Christina et al, dysphagia rarely occurred, counted for only 11% from 63 patients.…”