Esophageal substitution in children. Gastric transposition

Abstract

For a long time colonic esophagoplasty were operations in choice in our institution. From 2009 we introduce stomach esophagoplasty to evaluate the results and long-term outcome of this surgical option as well as to provide a comparative analysis of this technique and colonic esophagoplasty. Materials and methods. From January 2009 till May 2015 44 children underwent stomach esophagoplasty in Filatov Children’s Hospital, Moscow. The patients were aged from 2 months till 13 years. Esophageal atresia was present in 15 (34%) cases, esophageal strictures – in 16 (36.4%), peptic stenosis – in 8 (18.2%), other disorders – in 5 (%) children. To evaluate both short-term and long-term outcomes we consider the following data: clinical examination, questionnaires, esophago gastroduodenoscopy, X-ray contrast study of GIT. In 32 children (72.8%) the stomach was moved through the posterior mediastinum, in 12 (27.2%) patients – trough the anterior mediastinum. Complications. In early postoperative period we had the following complications: pneumonia, pneumothorax, gastric-intestinal bleeding, eventration, enterocolitis, jejunum perforation. In the long-term follow up we diagnosed stenosis of gastroesophagoanasthomosis, aspiration pneumonia, hiatal hernia. Discussion. Stomachesophagoplasty is more easy from the technical point of view. Operation time makes from 50 minutes till 2 o’clock and 40 minutes. We had no necrosis of transplant. In 8 children this operation was made after unsuccessful colonic esophagoplasty. Average stay in the intensive care unit was 6 days. Feeding behavior of the patients after stomach esophagoplasty is strictly regulated by the compelled guidelines. Conclusion. Stomach esophagoplasty has its advantages and drawbacks. Our experience presents the comparative analysis of the outcomes of colonic esophagoplasty and stomach esophagoplasty, guidelines of how to choose the best way of esophageal repair. The above described surgical option gives way to more opportunities for a surgeon and helps to improve treatment outcomes in children with esophageal disorders.