Long-Term Functional Results of Transhiatal Oesophagectomy and Colonic Interposition for Caustic Oesophageal Stricture

Abstract

Aim of the study. Various surgical procedures have been advocated for replacement of the scarred oesophagus in children. We report here on our experience of oesophago-coloplasty. Methods. Over a 10-year period, 100 children (62 boys, 38 girls) with intractable caustic stricture of the oesophagus underwent transhiatal oesophagectomy and left colonic interposition. Their age at the time of reconstruction ranged from 14 months to 8 years (mean 3.4 years). Results. The patients were followed up post reconstruction for a period ranging from 5 to 15 years. There were 3 deaths from respiratory failure. Stricture of the cervical oesophagocolic anastomosis occurred in 6 patients and needed repeated dilatations (in 2 patients) and surgical revision (in 4 patients). Mild redundancy of the colonic substitute in the chest was noted in five cases, but in no case there was dysphagia necessitating revision of the colonic transplant. Peptic ulcer or symptomatic gastric-colic reflux was not seen in this group of patients. All of our patients are able to swallow and eat a normal unrestricted diet, they are gaining weight and enjoying a normal life pattern. Conclusion. We conclude that isoperistaltic left colon, based on both the ascending and descending branches of the left colic vessels with simultaneous oesophagectomy utilising the transhiatal approach, is the best substitute for a scarred oesophagus in children with satisfactory long-term functional results.

Antesternal Colonic Interposition for Corrosive Esophageal Stricture

“…The timing of surgery is controversial. While reported best 6 months after initial injury [14], interval of 2-3 months was reported to be adequate by Munoz-Bongrand et al [15]. In our study, the mean timing of intervention was 4 months.…”

Laparoscopically assisted transhiatal esophagectomy with esophagogastroplasty for post-corrosive esophageal stricture treatment in children

“…The diaphragmatic crus was opened and transhiatal dissection of the oesophagus was continued under direct vision and very close to the esophageal wall by harmonic scalpel (Figs. [2][3][4]. A tunnel was created in the posterior mediastinum up to the middle of the thorax.…”

“…Various segments of the gastrointestinal tract have been used to replace the scarred esophagus; colon and stomach were the best oesophageal substitutes [2,3].…”

15-year Personal Experience of Esophageal Reconstruction by Left Colic Arterydependent Colic Graft for Caustic Stricture: Surgical Technique and Postoperative Results

“…The scar retraction began as early as the end of the second week, and lasted for about six months. It took about 6-12 months before full fibrosis stopped to develop after the injury which showed that the edge of the stricture in the esophagus might not be confirmed until then [14,15] . A too earlier operation, when the scar has not completely formed, may promote the risk of anastomotic leak and stenosis.…”

“…The causes were pulmonary emboli, myocardial infarcts and severe infectious complication with multi-organ failure. Nevertheless, the morbidity rate is still high and it ranges from 20% to 60% in the literature [12,14,16,17] . The morbidity in our series was 26.6 % (n=28).…”