Experiences of colonic replacement for severe postoperative complications of esophageal atresia and literature review

Abstract

Objective To explore the feasibility of managing such severe complications after anastomosis of esophageal atresia (EA) as anastomotic leakage and recurrent esophageal tracheal fistula. Methods From January 2007 to December 2015, 6 EA patients underwent colonic replacement. The clinical types were Ⅰ (n=2) and Ⅲa (n=4). Esophageal replacement was performed for refractory anastomotic leakage and recurrent trachea esophageal fistula after initial esophageal myomectomy and gastrostomy. Results Colonic replacement was performed successfully and all 6 patients were cured and discharged. There were proximal anastomotic leakage (n=4), anastomotic stricture (n=3), pulmonary infection (n=3) and bleeding of stress gastric ulcer (n=1). All complications were cured conservatively. The follow-up period lasted from 9 months to 10 years. All of them received oral feeding without dietary control and there was no occurrence of acid reflux, vomiting or oral odor. Physical growth and development stayed within the same range as counterparts of the same age. Conclusions Colonic replacement for esophagus is ideal for managing severe postoperative complications during esophageal myomectomy and gastrostomy of long gap EA, refractory anastomotic leakage and recurrent trachea esophageal fistula after esophageal anastomosis. Key words: Esophageal atresia; Complications; Esophagoplasty