Transhiatal esophagectomy with gastric transposition for esophageal replacement in post-corrosive stricture in children.

Abstract

Despite potential advantages of gastric transposition there are some concerns about this surgical technique of esophageal substitution in children. In the current study the morbidity and functional outcome are surveyed in a series of patients undergoing gastric transposition due to extensive post-corrosive esophageal strictures.Retrospective analysis of children proposed for esophageal replacement from September 2003 through April 2007 after endoscopic dilations failure. Demographic and pathological features, intra and postoperative complications and clinical outcome were assessed. Continuous variables are expressed as median [range].There were six children (age: 4.3 [2.5;14.4] years) with esophageal structures secondary to corrosive alkali ingestion; five had been submitted to dilation (n = 8 [7;27]) and one had undergone gastrostomy. Esophagectomy without thoracotomy plus gastric transposition were uneventfully performed in all cases. There was no mortality. On postoperative course there was one hypertensive pneumothorax and one pneumonia. With a follow-up of 50 [38;80] months, two children experienced mild dysphagia that was promptly solved by one or two sessions of dilations of esophagogastric anastomosis; both weight and height were between 5th and 75th centiles; none presented gastrointestinal or recurrent respiratory symptoms, anemia or substitute dilation. CONCLUSION. Transhiatal esophagectomy with gastric transposition in posterior mediastinum presented low morbidity and excellent functional outcome with no impairment of growth or respiratory function, at least on short/medium term.