14 Years’ Experience of Esophageal Replacement Surgeries

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14 Years’ Experience of Esophageal Replacement Surgeries


JournalPediatric Surgery International
Publication date – Mar – 2020
Authors – Muhammad Saleem, Asif Iqbal, Uzma Ather, Naveed Haider, Nabila Talat, Imran Hashim, Muhammad Bilal Mirza, Jamal Butt, Hassan Mahmud, and Fatima Majeed
KeywordsColonic interposition, Corrosive strictures, Esophageal atresia, Esophageal replacement, Gastric pull-up, Jejunal transposition, LMIC, Retrosternal route, Trans hiatal route
Open access – Yes
SpecialityPaediatric surgery
World region Southern Asia
Country: Pakistan
Language – English
Submitted to the One Surgery Index on May 20, 2020 at 8:13 am
Abstract:

Background
Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement.

Methodology
This study was conducted at the department of pediatric surgery The Children’s Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under follow-up were called for clinical evaluation and assessed of long terms complications if any.

Results
A total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%).

Conclusion
There are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors’ experience.

OSI Number – 20386
PMID – 32236666

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