ESOPHAGEAL REPLACEMENT IN CHILDREN

Abstract

Introduction: esophageal replacement in childhood, is indicated for intractable stenosis and long-gap atresia. When it is impossible to preserve the native esophagus we must create an appropriate conduit that should allow physiological oral feeding. Patients and Methods: we present two cases. The first patient, born with long gap esophageal atresia (AE), was submitted to ligation of fistula, gastrostomy and esophagostomy. When he was 1 years old came to our observation with two derivations. The radiological examination with contrast confirmed the large gap between the two oesophageal stumps. We decided to refer the patient to esophageal substitution with isoperistaltic jejunum through the posterior mediastinum. The second patient was born with AE type III and he was submitted to ligation of fistula, primary anastomosis, and 4 additional interventions of closure of recurrent fistula, esophageal resection and anti-reflux surgery. He came to our observation when he was 6 years old. The radiography showed esophageal dysmotility and dislocation of the stomach in the chest. We decided to subject the patient to esophageal replacement with stomach in toto. Results: Both patients had a good post-operative course. They began food orally in the first case in 18th day and in the second case in 7th. At follow-up after 1 year the children ate regularly, they don’t show respiratory symptoms or gastro-oesophageal reflux and they have a good growth. Conclusions: Esophageal replacement is a complex surgical procedure, which provides various options. Only a careful preoperative evaluation allows us a choice of organ to be used as esophageal substitute. The colon is the most widely used. There are other surgical options that may offer, in skilled hands, the same guarantees. Both our cases have a good long term follow-up with regular diet and weight-height growth. Our experience confirms the validity of the 2 techniques, which include preferably the use of posterior mediastinal way and careful surgical preparation of the bowels.