Surgical Complications Following Oesophageal Replacement by Stomach in Childhood

Overview

Aim:
Assessment of surgical complications and options for their therapy following replacement of oesophagus by stomach.

Methodology and Material:
A retrospective study of clinical and pathological data collected from 25 children, who underwent replacement procedures of their oesophagus by stomach during the 1992–2005 period. 18 subjects were indicated for the procedure for oesophageal atresia with large stubs distance and 7 subjects were indicated for extensive oesophageal strictures following acid burns.

Results:
The study group included 25 children whose mean age at the time of the procedure was 12.5 years (the age range 8 to 13.3 years). Early postoperatively, a fistule in the oesophageal anastomosis region was confirmed in 7 subjects (28%), however, in all cases it healed successfully on conservative management. In five cases (20%), a stricture in the pyloric region developed and in 4 cases it was managed using balloon dilation. During the long-term follow up period, oesophageal anastomosis stricutres were diagnosed in 9 children (36%). The problem was managed using repetitive balloon dilations. One child was operated for ileus with adhesions and in one child, a nutritional jejunostomy had to be re-conducted. One girl exited at home, a year following the procedure, due to respiratory arrest on aspiration.

Conclusions:
Transposition of the stomach is a suitable method of choice for oesophageal replacement in childhood, providing good quality of life for majority of patients. Early and late surgical complications correspond with a degree of seriousness of the disorder and require treatment and long term follow up to be conducted in a specialized clinic.

Key words:
oesophageal replacement – gastric transposition – oesophageal anastomotic stricture – anastomotic leak