Gastric Tube Interposition for Esophageal Replacement in Children, Is it the best option?

Ahmad Khaleghnejad Tabari, Mohsen Rouzrokh, Nasibeh Khaleghnejad Tabari

Abstract


163

Introduction: Replacement of esophagus can be accomplished using different parts of the gastrointestinal tract, in various positions and in single and multiple stages. The aim of this study is to present the results of gastric tube interposition in children with congenital esophageal anomalies and severe acquired esophageal stricture.

Material and Methods: This series describes 22 patients who underwent gastric tube interposition procedures for esophageal replacement at Mofid Children’s Hospital Tehran, Iran between 1996 and 2014. Clinical data including the indication for esophageal replacement, technique and timing of repair, early and late complications, and long-term follow-up were retrospectively gathered from patients’ medical records.

Results: Patients consisted of 17 Male and 5 female, aged 8 months to 14 years (mean 47.8 months). Twenty one patients had normal oral feeding and proper weight gain. The mean time of follow up was 9.25 years (9 months to 18 years). One of our cases developed failure to thrive although he had no difficulty in swallowing and was eventually put on supplementary feeding by gastrostomy.There were 3 strictures: one in the neck anastomosis which was treated by dilatation and revision of anastomosis, one in the hiatal level which was because of tight hiatus and was treated by widening of hiatus. The last patient had a stricture at mid-portion of gastric tube, and was treated by dilatation, which resulted in perforation and was treated by stricturoplasty. Three leaks occurred at the neck anastomosis, two healed spontaneously and one resulted in intra thoracic leak and mediastinitis that led to death after 3 months. Another child with lymphocyte adhesion deficiency died due to infected neck wound and severe bleeding from carotid artery 22 days postoperatively, a third death occurred many years after the original operation due to mediastinitis which was the result of dilatation for stricture formation.

Conclusions: Although gastric tube replacement in posterior mediastinum seems an ideal replacement because of adequate length which makes it easily reachable to pharynx, good blood supplies, straight and proper size; the management of complicated cases such as mediastinal leaks and strictures is very challenging and rules out this method of esophageal replacement as the best option possible.


Keywords


Gastric tube interposition; esophageal replacement; esophageal atresia; caustic injury

Full Text:

PDF

369

References


Burgos L, Barrena S, Andrés A. M, et al: Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. Journal of Pediatric Surgery 2010; 45: 341–345.

Gallo G, Zwaveling S, Van der Zee D.C, et al: A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia. Journal of Pediatric Surgery 2015; 50:535–539.

Spitz L: Esophageal replacement: Overcoming the need. Journal of Pediatric Surgery 2014; 49: 849–852.

Tannuri U, Maksoud-Filho J. G, TannuriA. C. A, et al: Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center. Journal of Pediatric Surgery 2007; 42: 500– 504.

Anderson KD, Randolph JG: Gastric tube interposition: a satisfactory alternative to the colon for esophageal replacement in children. Ann Thorac Surg 1978; 25(6): 521-5.

Anderson KD: Gastric tube esophagoplasty. ProgPediatrSurg1986; 19: 55-61.

Anderson KD. Noblett H. Belsey R. et al: Long-term follow-up of children with colon and gastric tube interposition for esophageal atresia. Surgery 1992; 111(2): 131-6.

Ashcraft KW. The esophagus. In: Ashcraft KW, Holcomb GW, Murphy JP. Pediatric surgery. 4th ed. Philadelphia: Elsevier Saunders, 2005: 330-351.

Borgnon J. Tounian P. Auber F. et al: Esophageal replacement in children by an isoperistaltic gastric tube: a 12-year experience. PediatrSurg Int 2004; 20(11-12): 829-33.

Canty TG Sr, LoSasso B.E: One-stage esophagectomy and in situ colon interposition for esophageal replacement in children. J PediatrSurg 1997; 32(2): 334-6.

Dillon PA. Esophagus. In: Oldham KT, Colombani PM, Foglia RP, Skinner MA. Principles and practice of pediatric surgery, Vol 2. Philadelphia: LWW, 2005: 1023-1038.

Ein SH: Gastric tubes in children with caustic esophageal injury: a 32-year review. J PediatrSurg 1998 Sep; 33(9): 1363-5.

Han MT. Ileocolic replacement of esophagus in children with esophageal stricture. J PediatrSurg 1991 Jul; 26(7): 755-7.

Heimlich HJ: Reversed gastric tube (RGT) esophagoplasty for failure of colon, jejunum and prosthetic interpositions. Ann Surg1975; 182(2): 154-60.

Hirschl RB, Yardeni D, Oldham K, et al: Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg. 2002; 236(4): 531-9.

Khan AR, Stiff G, Mohammed AR, et al:. Esophageal replacement with colon in children. PediatrSurgInt 1998; 13(2-3):79-83.

O’Niel JA. Esophageal stenosis, stricture and replacement. In: O’Neil JA, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA. Principles of pediatric surgery. 2nd ed. St. Louis: Mosby 2004: 395-403.

Pedersen JC. Klein RL. Andrews DA: Gastric tube as the primary procedure for pure esophageal atresia. J PediatrSurg 1996; 31(9):1233-5.

Saeki M. Tsuchida Y. Ogata T et al: Long-term results of jejunal replacement of the esophagus. J PediatrSurg1988; 23(5): 483-9.

Schettini ST. Pinus J: Gastric-tube esophagoplasty in children. PediatrSurgInt 1998; 14(1-2): 144-50.

Spitz L: Gastric transposition for esophageal substitution in children. J PediatrSurg 1992; 27(2): 252-7.

Spitz L, Kiely E, Pierro A: Gastric transposition in children-a 21-year experience. J PediatrSurg 2004; 39(3): 276-81.




DOI: https://doi.org/10.22037/irjps.v1i2.11527

Refbacks

  • There are currently no refbacks.


pISSN: 2423-5067

eISSN: 2423-7612

Creative Commons License
This journal and its contents are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.