Esophageal replacement by gastric transposition: A single surgeon's experience from a tertiary pediatric surgical center
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Read the article on jpedsurg.org ↗Article · Jun 2018 · 1 min read
In brief
In brief
Single-surgeon retrospective review of 19 pediatric patients undergoing gastric transposition for esophageal replacement over 28 years, primarily for long-gap esophageal atresia. Zero mortality with 10.5% anastomotic leak rate; patients demonstrated sustained weight gain trajectory with most achieving full oral feeding long-term.
Written by the GCMD Library team from the article.
Background
Many pediatric surgeons have limited experience of esophageal replacement. This study reports outcomes of esophageal replacement by gastric transposition performed by a single UK-based pediatric surgeon.
Methods
Consecutive patients were identified who underwent esophageal replacement by gastric transposition over a 28 year period. Clinical and demographic data were collected. Weight-for-age Z-scores were calculated for esophageal atresia patients.
Results
Nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n = 17; 10 with tracheoesophageal fistula). At surgery, median age was 8.5 months (range 2–55); median weight was 7.4 kg (range 4.0–17.4 kg). A right-sided thoracotomy or transhiatal approach was used. Median postoperative length of stay was 17.5 days (range 7–130); median intensive care stay was three days (range 1–63). There were no deaths. Anastomotic leak rate at 30 days was 10.5% (n = 2). One patient required early stricture dilatation. Median weight-for-age Z-score increased from −2.17 at one year of age to −1.86, −1.70 and −1.93 at 5, 10 and 15 years.
Conclusions
Esophageal replacement by gastric transposition offers a potentially life-changing treatment; however, it is associated with significant morbidity. The majority of patients eventually achieve full oral feeding and maintenance of weight gain trajectory. A right-sided approach to the esophagus is feasible.
Type of Study
Treatment Study.
Level of Evidence
IV.