DOZ047.118: Surgical treatment of children with button battery injury

Abstract

Abstract Introduction The foreign body of the esophagus—button battery causes severe changes of the esophagus. Ingestion of large-sized button batteries (≥20 mm) in children younger than 4 years is associated with increased morbidity and mortality. The most serious complication is the perforation of the esophagus or tracheoesophageal fistula (TEF), which may require a long-term multistage surgical treatment. Other issues that can be caused by button battery injury are esophageal stenosis and laryngeal paralysis. There are 40 children with esophageal injuries who were treated in Filatov Children Hospital between 2011 and 2019. Among them, several children did not need surgical treatment at all (40%), but five patients (12.5%) needed colon transposition. Button battery injury also causes reversible or irreversible damage of the recurrent laryngeal nerve, which required complex reconstructive operations on the larynx and trachea. Patients and Methods We retrospectively analyzed 40 patients with different types of injury after button battery removal. The average age of the patients was 1 year and 8 months. A total of 16 patients (40%) have had no esophageal or laryngeal pathology after button battery removal. Six patients (15%) developed esophageal stenosis. Two patients (5%) had esophageal perforations. Sixteen patients (40%) developed TEF. Bivocal chord paralysis was identified in 10 patients (25%). Results Esophageal dilations were performed in five patients (12.5%). Eight patients (20%) underwent laparoscopic fundoplication and gastrostomy. Spontaneous TEF closure formed in four patients (10%). Ten patients (25%) underwent different types of reconstructive surgeries in different periods after battery removal. Among eight patients (20%) who underwent early reconstructive surgeries three (7.5%) developed different complications, which require esophageal replacements. Tracheostomy was performed in 11 children (27.5%), five (12.5%) of whom required reconstructive surgery on the larynx. There was no mortality in our observation. Conclusion In this study, we conclude that TEF after button battery removal can close spontaneously and should not be operated in the acute period. Fundoplication and gastrostomy and tracheostomy can be procedures of choice in these patients. Also recurrent nerve injuries can be unstable. They can cause severe injuries of esophagus, trachea, and larynx, which can require esophageal replacement and vocal chord lateralization procedures with long-term and multiple-stage treatment.