Esophageal Substitution Research Articles

Long-Term Follow-up of Patients with Esophageal Replacement by Reversed Gastric Tube

Various surgical procedures are used for esophageal substitution in children. The purpose of this study was to evaluate the long-term outcome in children who underwent esophageal replacement by reversed gastric tube and to assess some aspects of the physiological function and behavior of the reversed gastric tube. This study was a retrospective and prospective review of 16 patients who had undergone reversed gastric tube esophagoplasty between March 1990 and March 2009. Indications for esophageal replacement included esophageal atresia with or without fistula (10) and caustic injury (6). There were 10 boys and 6 girls. Age at the time of this study varied from 1.7-20 years. The interval between operation and follow-up varied; it was more than 3 months in all cases, with an average of 8 months. Follow-up studies included clinical evaluation, anthropometry, barium study (to look for anastomotic leak, stricture, passage of contrast, ulcer, diverticulum, peristalsis and emptying), neoesophagus motility patterns by manometry, 24-h pH monitoring and radionuclide studies (to investigate esophageal transit and gastric emptying times and gastroesophageal reflux). Statistical analysis was carried out using STATA 9.0 and continuous variables were compared between the tests using the Wilcoxon rank sum test. Of the 16 children, 12 were between the 3 (rd) and 97 (th) percentiles for weight and 10 were between the 3 (rd) and 97 (th) percentiles for height for their respective age group. 14 were eating and swallowing normally. 2 patients had slight swallowing difficulties with lumpy foods but did not require dilatations. None of our patients had respiratory problems. The children with corrosive stricture were almost normal in growth and development compared to esophageal atresia patients. Barium swallow showed normal swallowing in all patients and did not show gastroesophageal reflux. Mass contractions were seen in two-thirds of the patients on manometry. 24-h pH monitoring showed that the intraluminal pH remained consistently low, even long after operative treatment. Scintigraphy and barium swallow showed almost similar results except that scintigraphy was much more sensitive in detecting reflux. Almost all children remained asymptomatic and led a normal life. The function of the neoesophagus was good and growth and nutrition in the majority of patients was satisfactory.

ESOPHAGEAL REPLACEMENT IN CHILDREN

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.

ESOPHAGEAL REPLACEMENT IN CHILDREN

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.

Chemical injuries of the oesophagus: aetiopathological issues in Nigeria

BackgroundChemical injuries of the oesophagus occur worldwide. There is paucity of information on aetiopathological profile of chemical injuries of the oesophagus in Nigeria.AimThe aim of the study was to determine the aetiopathological pattern of chemical injuries of the oesophagus in Nigeria.Materials and methodsThis is a multi-centre hospital based study in Lagos metropolis spanning a period of 10 years.The patients' bio data, substances ingested, sources of corrosives, reasons for ingesting corrosives and patients' mental state were recorded.ResultsIn all, there were 78 patients (61 Males, 17 Females). The offending agents were acids in 55.1% of cases and it was accidental ingestion in 62 patients. The highest incidence of 57.6% was found in the middle 1/3 of the oesophagus.ConclusionAccidental ingestion of acids is the commonest cause of oesophageal injuries in Nigeria. The incidence of severe strictures necessitating oesophageal substitution could be reduced if early management of corrosive oesophagitis improves in Nigeria.

Esophagectomy and substitution of the thoracic esophagus in dogs

To evaluate a technique to remove the thoracic esophagus without thoracotomy and two methods for thoracic esophageal replacement in dogs. 27 ex-vivo dogs were divided into three groups in order to evaluate: G1 - total thoracic esophagectomy by the everting stripping method; G2 - total thoracic esophagectomy and esophageal substitution using the whole stomach; G3 - total thoracic esophagectomy and esophageal substitution using fundus rotation gastroplasty. After esophageal resection in G1, the integrity of the intrathoracic route was evaluated by endoscopy and tested with 1% methylene blue solution. Visceral pleural rupture was observed in all animals. However, this intrathoracic route made it possible to bring both esophagus substitutes (G2 and G3) to be anastomosed to the cut end of the cervical esophagus. Thoracic esophageal substitution using the whole stomach showed less anastomotic tension and was less technically demanding than the fundus rotation gastroplasty method. The ex-vivo results support further studies to validate the techniques in clinical cases.

Surgical Treatment and Prognosis of Esophageal Cancer After Distal Gastrectomy

BackgroundThe purpose of the present study was to explore the clinicopathological characteristics and operative therapeutic efficacy of thoracic esophageal cancer after gastrectomy and compare with those without gastrectomy. MethodsFrom January 2000 to June 2007, 28 esophageal cancer patients with a history of distal gastrectomy underwent subtotal esophagectomy. Vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Six hundred seventeen patients without a history of gastrectomy treated in the same period form the control group. After the operation, pathological characteristic, tumor staging, and survival statistics were analyzed. ResultsOf those patients with esophageal cancer associated with gastric remnant, the majority were male. There was an average of 16.5 years for diagnosing esophageal cancer from the initial partial gastrectomy, 75% (21/28) of them were patients with Billroth I anastomosis. The proportion of lower-third tumors in patients after gastrectomy (12 of 28 patients, 43%) was significantly higher compared with that of the patients with intact stomachs (124 of 617 patients, 20%; P = 0.004). After surgical treatment, the overall 1-, 3-, and 5-year survival rates of gastrectomized and nongastrectomized patients were 100%, 35.00%, and 23.33% versus 98.93%, 59.42%, and 30.85% in stages I–II and 80.00%, 30.00%, and 0% versus 98.59%, 62.03%, and 21.03% in stages III–IV. The log rank test of equality of survival distribution for the gastrectomized vs nongastrectomized patients was not significant in stages I–II (P = 0.5692) but was significant in stages III–IV (P = 0.0166). ConclusionsThe patients with partial gastrectomy for more than 5 years, having upper gastrointestinal symptoms, should be considered having the risk of esophageal cancer associated with gastric remnant. For patients with a history of distal gastrectomy, a vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Surgical efficacy was similar with the no-gastrectomy group in early stages I–II of esophageal cancer associated with gastric remnant but was lower compared with the no-gastrectomy group in stages III–IV. So, early diagnosis and an aggressive surgical approach may be crucial to achieve better outcomes for esophageal cancer patients with gastrectomy.

Gastric transposition in children

To analyze the outcome in 192 children (116 males, 76 females) undergoing transposition since 1981. The most common indications for esophageal replacement included failed repair of different varieties of esophageal atresia (138), caustic injury (29), and peptic strictures (9). A total of 81% of the patients were referred from other hospitals (50% from other countries). Age at operation ranged from 7 days to 17 years. The gastric transposition was performed by using blunt mediastinal dissection in 98 patients, with an additional 90 patients undergoing lateral thoracotomy. The retrosternal position was used in 4 patients. There were no graft failures, including those who had previously had failed gastric tube or Scharli operations. Anastomotic leaks occurred in 12% (all but one resolved spontaneously). Anastomotic stricture, requiring dilation developed in 20%. Half of these patients had previously sustained caustic esophageal injury. There were 9 deaths in the group (4.6%). One death occurred intraoperatively, 5 in the early postoperative period, and there were 3 late deaths. In over 90% of our patients, the outcome was considered good to excellent in terms of absence of swallowing difficulties or other gastrointestinal symptoms. Many children preferred to eat small frequent meals. Poor outcome was particularly associated with multiple previous attempts at esophageal salvage. There was no deterioration in the function of the gastric transposition in those patients followed for more than 10 years. Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 4.6% mortality and a 12% leak rate. A total of 20% of the patients needed anastomotic dilation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with other methods of esophageal replacement.

Laryngotracheal canal for hypopharyngoesophageal stricture after corrosive injury

Aim To evaluate the application of the laryngotracheal canal on the reconstruction of the hypopharyngoesophageal defect resulting from resection of stricture with corrosive injury. Method Ten patients with the hypopharyngoesophageal stricture after corrosive injury due to ingestion of strong alkali in two cases and strong acid in eight treated surgically from January 2005 to December 2007 were studied. Lipiodol esophagography revealed almost complete obliteration of both sides of sinus piriformis in seven patients and stricture of the lower hypopharynx in two cases, and laryngofiberscopy revealed injury of vocal cord in one case. All patients received the operation of the laryngotracheal canal. As an isoperistaltic conduit in eight and an antiperistaltic in two, the colon was placed retrosternally anastomosed with lower margin of larynx for esophageal substitution. Result All patients healed well. No anastomotic leakage was observed. Normal deglutition and weight gain were achieved in all the patients. Postoperative follow-up endoscopy showed no stricture recurrence of anastomosis. Functional results of nine patients (90%) were categorized as good result; only one (10%) faired. Conclusion The application of the laryngotracheal canal therefore can be advocated as the method for reconstruction of the hypopharyngoesophageal defect after resection of stricture due to corrosive injury.

Esophageal surgery in newborns, infants and children

The most common surgery on the esophagus by pediatric surgeons the world over is performed in the newborn period in babies with congenital esophageal atresia with tracheo-esophageal fistula. Post-operative complications like recurrent fistula, anastomotic stricture and some patients with gastroesophageal reflux would also require surgical intervention. Apart from esophageal dilatation, gastrostomy and feeding jejunostomy, children with strictures secondary to caustic ingestion, reflux or previous esophageal anastomosis may require esophageal substitution. This operation may also be required in babies with pure esophageal atresia as well as those with a long gap esophageal atresia with fistula. The entire stomach, stomach tubes, colon or jejunum are often used but techniques preserving as much of the original esophagus as possible are preferable and more physiological. Surgery is also required in children with congenital esophageal stenosis and duplication cyst.

Esophageal Substitution for Esophageal Atresia: Experience with Neonatal Gastric Transposition

The best possible procedure for esophageal replacement is an ongoing debate. Most procedures are adopted on the basis of personal experience, available resources and the familiarity with the procedure. There is very sparse experience with esophageal replacement in the neonatal period. This article reviews the available literature on early replacement for esophageal atresia and tracheoesophageal fistula. Gastric transposition at an early age has stood the initial test of time and the personal experience with this procedure is described. Gastric pull-up could be a lifesaving alternative to diversion, even in the critically ill newborns following major leaks. However, it requires technical expertise and intensive care monitoring at tertiary care-level centers.

Substernal long segment left colon interposition for oesophageal replacement

Long segments of colon, transposed on a vascular pedicle, have been used for oesophageal substitution for a long time. However the techniques employed for colonic reconstruction remain debated. We describe our substernal long segment replacement technique and emphasise several key aspects which are important in management of these patients. Optimising nutritional status and pulmonary function remain important aspects. Thymectomy allows room for the colonic segment preventing venous congestion. These patients are best managed in specialist units incorporating a multidisciplinary approach with good intensive care and radiological support.

Isolated Ultra-Long Gap Esophageal Atresia - Successful Use of the Foker Technique

Ultra-long gap (> 3.5 cm) esophageal atresias (ULGEA) are very rare congenital disorders usually treated by esophageal substitution. Since the introduction of Foker's elongation technique for primary anastomosis, there is much controversy over whether the Foker method or esophageal substitution results in a better outcome. Until now, there was only one series, which had been reported by Foker himself. We therefore present the outcome 2.5 years after one of the first children was operated on with the Foker method in Europe (2003). A premature child (1820 g, 33 + 4 gestational week) born with isolated ULGEA (6-cm gap length/30.5-cm body length) was treated with the Foker technique. We present a critical review of the course together with any complications that can help in the clinical evaluation of the new technique. Three thoracotomies and 5 dilating procedures over a period of 3 months were necessary to achieve primary anastomosis. Two major complications occurred (anastomotic leak and subsequent stricture). The boy was under mechanical ventilation for a total of 15 days. The Foker method seems to be quite feasible and quickly results in the expected primary anastomosis. The result in this single case is excellent.

Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center

Background/Purpose Esophagocoloplasty and gastric transposition are 2 major methods of esophageal substitution in children. The purpose of this study is to review the authors' experience with these 2 techniques and compare the complications of these operations to determine whether 1 method emerges superior to the other. Methods A total of 149 children underwent surgery: 115 children underwent esophagocoloplasty, and 34 children underwent gastric transposition. Most patients (113-75.8%) had long-gap esophageal atresia. The operative technique of esophagocoloplasty consisted of the interposition of the transverse colon maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade. Gastric transposition was performed according to classical technique. The transposition of colon and stomach was performed using blunt mediastinal dissection in all patients without thoracotomy. Complications and mortality of the 2 groups of patients were compared. These complications were classified as minor (cervical anastomosis leak, abdominal evisceration, diarrhea, strictures, and reflux to the interposed viscera) and major (necrosis of transposed viscera, dehiscence of an intra-abdominal or intrapleural suture, torsion of transposed viscera, delayed gastric emptying requiring reoperation, and cologastric anastomosis stricture). Results There were 2 graft necrosis, 1 (0.8%) in the esophagocoloplasty group and another (2.9%) in the gastric transposition group. Patients who underwent esophagocoloplasty experienced a greater incidence of minor complications ( P = .001) and less major complications in comparison with the gastric transposition group ( P = .001). All minor complications were treatable and had no consequences. No difference was noted between the 2 groups with regard to the mortality rate (0.9% and 5.9%, respectively, P > .05). Conclusions Esophagocoloplasty and gastric transposition are satisfactory means of esophageal substitution in children. Considering the incidence of major postoperative complications, esophagocoloplasty must be the first choice for esophageal replacement in children.

Use of the Stomach as an Esophageal Substitute after Total Pharyngolaryngoesophagectomy for Treating Cervical Esophageal Cancer or Hypopharyngeal Cancer

Purpose: The aim of this study was to analyze the post operative outcome of reconstruction with using the stomach after performing total pharyngolaryngoesophagectomy in patients with hypopharyngeal cancer or cervical esophageal cancer. Materials and Methods: We conducted a retrospective chart review of 23 patients who underwent gastric pull up for esophageal substitution at the Department of Surgery, Yonsei University College of Medicine, between January 1991 and December 2006. All the patients had transhiatal esophagectomy performed without thoracotomy. Results: There were seventeen males and six females with a median age of 58.1 years (range: 40-70 years). 19 cases were hypopharyngeal cancer, 13 cases had cancer in the pyriform sinus, 15 cases had cancer in the postcricoid area and one case had cancer in the glottic area. The rest were cervical esophageal cancers. The pathologic result was squamous cell carcinoma in all cases. The median total follow-up period was 33 months (range: 1-62 months) and there were two (8.6%) postoperative deaths: one was due to carotid rupture and the other was due to hepatic failure with liver metastasis. The complications were leakage in 1 patient (4.4%), pneumothorax in 1 patient (4.4%) and pneumonia in 1 patient (4.4%). Conclusion: The use of stomach for esophageal reconstruction has many benefits for treating hypopharyngeal cancer or cervical esophageal cancer, So, we made sure there was a sufficient length for the anastomosis after pharyngolaryngoesophagectomy and a rich blood supply from the stomach. There was a low incidence of the leakage at the anastomotic site, along with a low incidence of stenosis and bleeding.

Esophageal reconstruction with intraoperative dilatation of the hypopharynx for the management of chronic corrosive esophageal strictures.

Chronic corrosive strictures of the upper cervical esophagus and hypopharynx resulting from ingestion of caustic substances are a challenging surgical entity when repeated endoscopic dilatations fail to yield satisfactory results. Restoring the continuity of the upper digestive tract by esophageal substitution at healthy tissue margins not only compromises the integrity of the swallowing mechanism, but also often requires the performance of a tracheostomy in order to ensure avoidance of recurrent aspirations. We describe three cases of corrosive upper cervical esophageal strictures treated with intraoperative dilatation of the proximal hypopharyngeal stump and concurrent 'stenting' of the pharyngeal anastomosis with the conduit replacing the esophagus. All patients tolerated the procedure well. Avoidance of both impairment of deglutition and respiratory complications, as well as restoration of normal esophageal function, was successfully accomplished.

Regeneration of the esophagus using gastric acellular matrix: an experimental study in a rat model

Recently, tissue engineering of the autologous esophagus has been thought to provide a promising strategy for esophageal substitution. In this study, gastric acellular matrix (GAM) was used as a scaffold for regeneration of the esophagus in a rat model. Usage of GAM has an advantage that naturally derived extracellular matrix autograft can be prepared less invasively in a clinical setting. Twenty-seven F344 female rats were used as recipients. Patch defects created in the abdominal esophagus were replaced by GAM patch grafts. The rats were sacrificed 1 week to 18 months after implantation. The specimen was examined macroscopically as well as microscopically. 5'-Bromo-2'-deoxyuridine (BrdU) proliferation assay was performed in six rats that were sacrificed 1, 2, and 4 weeks after implantation. Twenty-four rats survived without complications. The graft site did not show esophageal stenosis or dilatation in any rat. Keratinized stratified squamous esophageal mucosa was regenerated in the entire graft 2 weeks after implantation. Regeneration of the muscle layer or lamina muscularis mucosae in the graft site was not observed even 18 months after implantation. Marked incorporation of BrdU was observed only in the mucosal layer but not in the muscle layer. GAM patch graft provided satisfactory mucosal regeneration of the esophagus without stenosis or dilatation, although muscle regeneration was still a future challenge.

Oesophageal substitution with free and pedicled jejunum: short- and long-term outcomes

In children, the indications for oesophageal substitution are principally, long gap oesophageal atresia (OA), severe anastomotic disruption following primary repair of OA and severe caustic or peptic strictures. We present an outcome review of eight cases who underwent oesophageal substitution with jejunum at our institution between 1986 and 2001. The purpose of this study was to evaluate our experience with free/pedicled jejunal grafts and its long-term outcome as an oesophageal substitute. Operative and postoperative outcome with free and pedicled jejunal grafts in four cases of pure OA, two cases of OA and distal tracheo-oesophageal fistula (TOF), one patient with a high retrolaryngeal oesophageal web and one case of severe caustic oesophageal stricture. Six patients had an oesophagostomy and a gastrostomy fashioned previously. Eleven free jejunal grafts were performed in six patients (three intraoperative redo interpositions for immediate graft loss, three separate grafts in one patient and two free grafts in two patients). One patient's pedicled jejunal graft proximally required microvascular anastomosis while the other had a pedicled graft without microvascular anastomosis. Early postoperative complications included four upper anastomotic leaks (three free grafts, one pedicled with microvascular support), pneumothorax requiring prolonged ventilation and Horner's syndrome. Recurrent laryngeal nerve injury occurred in the patient who had a high retrolaryngeal oesophageal web. During follow up (5-18 years) late complications of upper anastomotic stricture in four patients and graft redundancy with subsequent kinking of the lower anastomosis were observed in one patient. Three patients established a complete oral diet; a further three patients relied on supplemental gastrostomy feeds and one patient is entirely gastrostomy fed. There were two late deaths, one from aspiration and the other from a severe asthmatic attack (5 and 7 months postoperatively, respectively). Our results indicate that there are significant complications related to the use of free jejunal grafts. Early recognition and treatment are of paramount importance in the ultimate achievement of a successful technical outcome.

Ghrelin reduction after esophageal substitution and its correlation to postoperative body weight loss in esophageal cancer patients

Body weight loss is observed commonly after esophagectomy with gastric tube reconstruction in thoracic esophageal cancer patients. The functional and anatomical alteration of the stomach by this surgery should affect ghrelin secretion, a novel gastric hormone that upregulates body weight through appetite control and metabolic reaction. Early-phase postoperative alteration of serum ghrelin was measured before and at day 3 and day 7 after surgery in 9 patients. With 26 other patients, who had previously undergone surgery from 3 months to 67 months (mean, 25 months) before the present study period, the late-phase postoperative alteration of serum ghrelin was investigated along with postoperative body weight loss and serum leptin. Serum ghrelin concentration, which was equivalent to the control group before surgery (88.6 fmol/mL vs 97.5 fmol/mL) significantly decreased by half at 3 and 7 days after surgery. Thereafter, the serum ghrelin decline continued in the outpatients within 1 year after surgery (58.8 fmol/mL), while it was marginal in those from 1 to 3 years after surgery (77.2 fmol/mL). Serum ghrelin was significantly higher than the control after 3 years (185.1 fmol/mL). Thus, a significant positive correlation was observed between ghrelin and time after surgery (P < .0001). Postoperative body weight loss was significant, averaged as DeltaBMI - 2.7 in the outpatients (P < .0001). Until 3 years after surgery, a significant correlation between ghrelin and postoperative body weight loss was observed (P = .0152), with those having higher serum ghrelin showing less body weight loss. Serum leptin correlated well with body weight (P = .0144), but not with postoperative time, the degree of body weight loss, or serum ghrelin concentration. Gastric tube replacement for esophagectomy resulted in temporary reduction of ghrelin production, which is associated with body weight loss after surgery. The decline of ghrelin may play some role in the serious body weight loss after esophagectomy, thus encouraging clinical application of exogenous recombinant ghrelin for these patients.

Surgical treatment of perforation with esophageal carcinoma

Perforation in esophageal carcinoma usually occurs at late stage, and is often accompanied with thoracic infections. Conventional conservative treatments, including parenteral nutritional support and stent placement under the endoscope, can neither eliminate the carcinoma nor control the infection completely. The mortality soon after perforation is fairly high. This study was to investigate the ideal operation patterns and perioperative treatment of perforation in esophageal carcinoma. A total of 41 patients with esophageal carcinoma perforated the right lung (19 cases), the mediastinum (17 cases) and the trachea (5 cases) were treated with operations: 39 underwent open thoracic operation, and 2 only underwent palliative gastric ostomy. Of the 39 patients, 16 received operation through the right thoracic approach with 3 incisions, and 23 received staging operation; 35 received retrosternal substitution of esophagus with stomach or colon, 4 underwent substitution of the esophagus with stomach via the esophageal bed. The operations were success in 36 cases. The patients could eat and take care of themselves. The patients were followed up for 3-72 months after operation: 2 survived for 3 months, 31 survived for 6-12 months, 2 survived for 24 months, and 1 survived for 72 months; 2 died during operation and 3 dead in 1 month after discharge. Of the latter 3 patients, 2 had underwent palliative gastric ostomy, 1 had stoma tracheal fistula recanalization. The surgical treatment of perforation in esophageal carcinoma could improve the survival rate and life quality of the patients. We suggest to perform retrosternal replacement of esophagus with stomach or colon through the right thoracic approach with 3 incisions or staging operations for the patients with perforation in carcinoma.

Isolated isoperistaltic gastric tube interposition for esophageal replacement in children

Various surgical procedures are used for esophageal substitution in children. With the gastric tube (GT) esophagoplasty procedures, main complications in the long term are related to gastric content reflux and acid production from the GT itself. A case of children operated on with a new procedure of isoperistaltic isolated GT interposition with favorable short- and long-term functional results is presented.