Outcomes of Esophageal Replacement: Gastric Pull-Up and Colonic Interposition Procedures

被引:9
|
作者
Bradshaw, Catherine Jane [1 ,2 ,3 ]
Sloan, Keren [1 ]
Morandi, Anna [2 ,3 ]
Lakshminarayanan, Bhanumathi [1 ]
Cox, Sharon Gail [2 ,3 ,4 ]
Millar, Alastair J. W. [2 ,3 ]
Numanoglu, Alp [2 ,3 ,4 ]
Lakhoo, Kokila [1 ]
机构
[1] Oxford Univ Hosp NHS Fdn Trust, Dept Paediat Surg, Headley Way, Oxford OX3 9DU, England
[2] Red Cross War Mem Childrens Hosp, Dept Paediat Surg, Cape Town, Western Cape Pr, South Africa
[3] Inst Child Hlth, Cape Town, Western Cape Pr, South Africa
[4] Univ Cape Town, Dept Paediat Surg, Cape Town, Western Cape, South Africa
关键词
colonic interposition; gastric pull-up; esophageal replacement; esophageal atresia; caustic ingestion injury; FOLLOW-UP; CHILDREN; ATRESIA; TRANSPOSITION; EXPERIENCE; RECONSTRUCTION;
D O I
10.1055/s-0037-1607041
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Aim No consensus exists about the optimal surgical technique for esophageal replacement. This study reports the surgical outcomes for the gastric pull-up and the colonic interposition procedures. Materials and Methods A retrospective review of children undergoing esophageal replacement surgery between January 2001 and June 2015 across four different pediatric surgery centers was conducted. Data collected included indications, epidemiology, surgical technique, complications, and outcomes. Patients were divided into group A, those that had a gastric pull-up procedure and group B, those that had a colonic interposition procedure. Results In total, 50 patients were included; 29 in group A and 21 in group B. Indications included esophageal atresia, caustic ingestion, and infective esophageal stricture. The median age at the time of surgery was 13 months. The mean length of follow-up was 5.2 years. Three patients died giving a mortality rate of 6%; 2 in group A and 1 in group B. In both groups, early postoperative complications included infective complications, such as wound infections, sepsis, and pneumonia (11), anastomotic leak (7), and respiratory complications (7). Late complications included adhesive bowel obstruction (2), anastomotic strictures (4), redundancy (1), and jejunostomy problems (1). Septic complications and anastomotic strictures occurred more frequently in group B. Further surgery was needed in eight patients; this was significantly higher in group B. Full oral feeding was achieved within 6 months in 91.5%. Conclusion The gastric pull-up and colonic interposition have comparable mortality and outcomes. The colonic interposition was associated with a higher rate of early septic complications, anastomotic strictures, and need for further surgery.
引用
收藏
页码:22 / 29
页数:8
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