Esophageal reconstruction in the treatment of caustic esophageal strictures in children; [Çocukluk çaǧi kostik özofagus darliklarinin tedavisinde özofagus rekonstrüksiyonlari]
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Date
2001
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Abstract
Aim: The incidence of esophageal strictures in children due to caustic ingestion shows a descending trend but still keeps its importance. In severe cases, who are resistant to medical treatment, several surgical interventions are proposed in repair of the constricted esophagus. The aim in the present study is to summarize the experiences in the technical approach. Method: In 1277 patients who were admitted to Pediatric Surgery Department of Faculty of Medicine of Ege University between the years 1975-1999 only 123 underwent corrective surgical treatment of the esophagus. Results of the different surgical approaches, complications, relations of the complications with the treatment applied, treatment applied for complications and morbidity were retrospectively reviewed. Results: In a total of 102 cases coloesophagoplasty was applied, in 10. through right thoracic retrohilar path and in 92 by retrosternal colon interposition. In 2 cases (2 %) necrosis was seen whole transplant and in 3 cases only at the cervical end of the transplant. When cases were evaluated according to the application of anastomosis in the first or second sequences, anastomosal stricture was seen in 6 of 12 cases (50 %) in the former, but in only 8 of 80 cases (10 %) in the latter. It was clearly seen that correction in the second sequence leads to less strictures. Grafts were widened and elongated in 7 of 10 cases with right thoracic retrohilar colon interposition, however in cases whom the transplants were placed retrosternally the graft widening and elongation were of lesser problem. To three cases jejunoesophagoplasty applied and in one case terminal necrosis and in 2 cases total necrosis were seen. In the remaining 18 cases in the present series, the intra thoracic esophageal stricture resection and end to end anastomosis were applied, Total overall mortality rate was 3.25 % (4 of 123). Conclusion: In the surgical treatment of esophageal strictures, if possible, a stricture resection and primary anastomosis should be undertaken. Otherwise a coloesophagoplasty with left colon through retrosternal path in two sequence seems more appropriate and has good outcome with low complication rate.