14 Years’ experience of esophageal replacement surgeries

Abstract

Background Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement. Methodology This study was conducted at the department of pediatric surgery The Children's Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under followup were called for clinical evaluation and assessed of long terms complications if any. Results A total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%). Conclusion There are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors' experience.

Hospital Process of Children with Ingested Corrosive Substances: A Single Center Retrospective Study in Türkiye

“…[10][11][12] Mitomycin C and intralesional steroid administration are recommended to increase dilatation efficiency. [14][15][16][17][18][19] In the study of Divarci et al, steroid and mitomycin C applications in the treatment of esophageal strictures were found to have a positive effect on resistant strictures. 18,19 However, steroids were found to be effective only in short segment esophageal strictures and not in the long segment.…”

“…The stricture may recur after initial dilatation, but typically starts to decrease over time. [12][13][14][15][16] Various treatment modalities such as steroid injection, mitomycin C administration or esophageal stenting are recommended in the literature to increase the efficiency of endoscopic dilatations. [17][18][19][20] However, dilatation may fail in severe esophageal strictures.…”

“…[17][18][19][20] However, dilatation may fail in severe esophageal strictures. 11,[15][16][17][18][19][20] Major surgical treatment is then required, i.e., performing esophageal replacement surgeries using the stomach, jejunum or colon. 15 The organ to be chosen for replacement varies depending on the patient's esophagus and stomach surgeries, the degree of corrosive injury and the competence of the institution.…”

“…11,[15][16][17][18][19][20] Major surgical treatment is then required, i.e., performing esophageal replacement surgeries using the stomach, jejunum or colon. 15 The organ to be chosen for replacement varies depending on the patient's esophagus and stomach surgeries, the degree of corrosive injury and the competence of the institution. 11,14 Patients with ingested corrosive esophageal are very difficult to treat, regardless of the cause of the injury, especially children who develop esophageal strictures, since the treatment and care process take many years, the quality of life of the children decreases, a feeling of guilt develops in the parents and the burden of care increases.…”

Kluth type I-2 variant of pure esophageal atresia – First case report and challenges in its management

“…Cervical esophagostomy and feeding gastrostomy are the most common procedures done initially for PEA, especially in the Indian subcontinent. [ 3 ] Authors prefer gastric transposition via posterior mediastinum being the shortest route. But, in this variant, due to absent lower esophageal pouch and diaphragmatic esophageal hiatus, there was no natural anatomical plane to create posterior mediastinal space for the gastric pull-up.…”