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Review
. 2008 Jan;90(1):7-12.
doi: 10.1308/003588408X242222.

Oesophageal replacement in children

G S Arul  1 , D Parikh
Affiliations
Review

Oesophageal replacement in children

G S Arul et al. Ann R Coll Surg Engl. 2008 Jan.

Abstract

Introduction: The usual indications for oesophageal replacement in childhood are intractable corrosive strictures and long-gap oesophageal atresia. Generally, paediatric surgeons attempt to preserve the native oesophagus with repeat dilatations. However, when this is not successful, an appropriate conduit must be fashioned to replace the oesophagus. The neo-oesophagus should allow normal oral feeding, not have gastro-oesophageal reflux, and be able to function well for the life-time of the patient.

Patients and methods: A Medline search for oesophageal replacement, oesophageal atresia, gastric transposition, colon transposition, gastric tube, caustic stricture was conducted. The commonest conduits including whole stomach, gastric tube, colon and jejunum are all discussed.

Results: No randomised controlled studies exist comparing the different types of conduits available for children. The techniques used tend to be based on personal preference and local experience rather than on any discernible objective data. The biggest series with long-term outcome are reported for gastric transposition and colon replacement. Comparison of a number of studies shows no significant difference in early or late complications. Early operative complications include graft necrosis, anastomotic leaks and sepsis. Late problems include strictures, poor feeding, gastro-oesophageal reflux, tortuosity of the graft and the development of Barrett's oesophagus. The biggest series, however, seem to have lower complications than small series probably reflecting the experience, built up over years, in their respective centres.

Conclusions: Long-term follow-up is recommended because of the risks of late strictures, excessive tortuosity of the neo-oesophagus and the development of Barrett's oesophagus.

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Figures

Figure 1
Figure 1
Gastric transposition (note a pyloroplasty has been done).
Figure 2A
Figure 2A
Reversed gastric tube. The gastro-epiploic arcade has been divided and an incision has been marked along the great curve of the stomach.
Figure 2B
Figure 2B
Reversed gastric tube. The section of greater curve has been tubularised and pulled up into the chest on a mesentry of the left gastro-epiploic artery.
Figure 3
Figure 3
Colon interposition (a pyloroplasty has been done).
See this image and copyright information in PMC

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