Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture

Abstract

Esophageal substitution in children is a rare and challenging surgery. The minimally invasive approach for esophageal substitution is novel and reported from a few centers worldwide. While detailed report on the various complications of this approach has been discussed in adult literature, the pediatric experience is rather limited. We report the laparoscopic management of a rare complication which developed after laparoscopic esophagectomy and esophageal substitution. The timely recognition and management by the minimally invasive approach have been highlighted.

Minimal access surgery of corrosive and thermal strictures of the foregut

“…[ 37 ] Existing gastrostomies can be taken down using endostapler or intra/extra-corporeal sutures and the defect utilised for siting larger port or miniceliotomy. [ 13 , 14 , 16 , 19 , 20 , 30 ] Alteration in the port positions avoiding the feeding access is feasible and often prudent [ Table 2 ]. [ 19 , 23 , 24 , 32 , 35 ] Ports for laparoscopic gastro-jejunostomy and antroduodenostomy remain as above or may be reduced, if extra-corporeal anastomosis is planned.…”

“…[ 11 , 12 , 22 , 23 , 32 , 41 ] Post-operative ventilation is scarcely required, excepting peri-operative period and more in children than adults. [ 11 , 12 , 15 , 19 – 21 , 27 , 30 , 37 , 41 ]…”

“…[ 6 , 8 – 51 ] Unfortunately, repeated interventions create diverticulae and micro-ruptures which perpetuate inflammation and fibrosis. [ 13 , 25 , 30 , 40 ] Hence, the 3-6 months period prescribed for subsidence of inflammation may prove inadequate for definitive surgery [ Table 2 ]. [ 53 ] Longer time lag renders resection easier and safer.…”