Gastric Tube Interposition for Esophageal Replacement in Children, Is it the best option?

Abstract

Introduction: Replacement of esophagus can be accomplished using different parts of the gastrointestinal tract, in various positions and in single and multiple stages. The aim of this study is to present the results of gastric tube interposition in children with congenital esophageal anomalies and severe acquired esophageal stricture.Material and Methods: This series describes 22 patients who underwent gastric tube interposition procedures for esophageal replacement at Mofid Children’s Hospital Tehran, Iran between 1996 and 2014. Clinical data including the indication for esophageal replacement, technique and timing of repair, early and late complications, and long-term follow-up were retrospectively gathered from patients’ medical records.Results: Patients consisted of 17 Male and 5 female, aged 8 months to 14 years (mean 47.8 months). Twenty one patients had normal oral feeding and proper weight gain. The mean time of follow up was 9.25 years (9 months to 18 years). One of our cases developed failure to thrive although he had no difficulty in swallowing and was eventually put on supplementary feeding by gastrostomy.There were 3 strictures: one in the neck anastomosis which was treated by dilatation and revision of anastomosis, one in the hiatal level which was because of tight hiatus and was treated by widening of hiatus. The last patient had a stricture at mid-portion of gastric tube, and was treated by dilatation, which resulted in perforation and was treated by stricturoplasty. Three leaks occurred at the neck anastomosis, two healed spontaneously and one resulted in intra thoracic leak and mediastinitis that led to death after 3 months. Another child with lymphocyte adhesion deficiency died due to infected neck wound and severe bleeding from carotid artery 22 days postoperatively, a third death occurred many years after the original operation due to mediastinitis which was the result of dilatation for stricture formation.Conclusions: Although gastric tube replacement in posterior mediastinum seems an ideal replacement because of adequate length which makes it easily reachable to pharynx, good blood supplies, straight and proper size; the management of complicated cases such as mediastinal leaks and strictures is very challenging and rules out this method of esophageal replacement as the best option possible.