A further look at the gastric tube as an esophageal replacement in infants and children

Abstract

Gastric tubes were constructed for infants with pure esophageal atresia as well as for “impossible” or “failed” repairs of esophageal atresia, and for children with esophageal stricture as well. More than two-thirds of the patients had the gastric tube operation before 2 yr of age (esophageal atresia). The children with esophageal strictures had the operation usually between 2 and 10 yr. The two-stage retrosternal reversed gastric tube was used most frequently. The isoperistaltic tube is an excellent alternate method should a reversed gastric tube be impossible to construct. If the gastric tube is short and used as an esophageal interposition in a patient with peptic esophagitis, there is a good possibility of developing esophagitis above the esophagogastric tube anastomosis. The most common complications that arise are related to the esophagogastric tube anastomosis (leak and stricture). We have found no correlation between the operative technique, the postoperative management as it concerns esophageal suction, and the eventual early or late anastomotic leak. Nor were these factors related to the time of eventual closure of the leak, the presence and severity of any subsequent stricture, and the results of its dilatation. The longest follow-up is 712 yr. Once the esophagogastric tube anastomosis has been healed and asymptomatic for 1 yr, the child is well on the way to a life of normal swallowing.