Esophagoplasty for caustic esophageal burns in children

Abstract

One hundred and two children with caustic esophageal strictures requiring esophagoplasty are reported. Seventy-one had a retrosternal colon transplant: two-stage esophagocolostomy in 59 and one-stage cervical anastomosis in 12. In the retrosternal group there were 2 cases of total transplant necrosis and 3 cases of terminal necrosis of the cervical end of the transplant; 12 patients developed anastomotic stenosis at the cervical end of the transplant. The incidence of cervical anastomotic stenosis was 50% in the single-stage group compared to 10% in the two-stage group. Ten patients underwent a right thoracic retrohilar colon transplant; 7 (90%) had evidence of redundancy of the graft compared to 10% in the retrosternal group. Three patients had a jejunoesophagoplasty that resulted in total transplant necrosis in 2 cases and terminal necrosis in 1. The remaining 18 patients had segmental resection of the intrathoracic esophageal stenosis followed by end-to-end anastomosis. The overall mortality was 3%. Twenty-six patients were followed up for 12 years: 21 (80%) had excellent results and 5 (20%) had residual problems. In our experience, although various esophagoplasty techniques are available with acceptable mortality, the associated morbidity remains significant since none of these patients has normal esophageal motility after the substitution procedure. Therefore, every effort should be made to preserve the patient's own esophagus.