Gastric-tube esophagoplasty in children

From 1979 to 1996, 19 patients underwent gastric-tube esophagoplasty. There were 10 boys and 9 girls, aged between 1 year 4 months and 4 years 11 mont hs at the time of surgery. In I patient the esophagoplasty was performed du e to a long stenosis secondary to reflux; 3 others had caustic stenoses; an d the remaining patients had esophageal atresia. In 17 cases an isoperistal tic gastric tube was brought up to the neck through the retrosternal space; in 2 an anisoperistaltic gastric tube was used, cervical mobilization bein g via the posterior mediastinum without a thoracotomy in 1 case and by the left transpleural route in the other. The cervical anastomosis was carried out in one surgical stage in 12 patients and in two stages in 7. In 1 patie nt the tube was resected due to necrosis of its proximal third; the child l ater underwent an esophagocoloplasty. Necrosis of the colic graft, mediasti nitis, and septicemia occurred, leading to the only death in the series. Th ere were 12 fistulas of the cervical anastomosis (63.3%) and 8 stenoses (42 .1%). All fistulas, with I exception, closed spontaneously after 8 days to 2 months, and all stenoses were treated by endoscopic dilatation. Another p atient developed a fistula of the gastric tube with chronic evolution to a stenosis of the distal third of the tube and communication with the right f ewer pulmonary lobe. A lobectomy and closure of the fistula were necessary. All patients were followed for a period of 1 to 16 years. At present, all of them swallow solid food normally. The evolution of the nutritional statu s was normal (eutrophic) in 14 of the fs patients (77.7%) who survived the operation; 4 showed variable degrees of malnutrition. In 2, of these 4 case s the malnutrition was due to poor socioeconomic conditions, but was not re lated to the surgery. Redundancy, a problem associated with esophagocolopla sty, was not observed in any of the gastric tubes, which was attributed to the thickness of the gastric wall. The authors prefer the use of an isoperi staltic gastric tube (with proximal base) for esophageal replacement in chi ldren and recommend that the operation should be carried out when the child is able to swallow solid foods and walk. As in any other major surgical pr ocedure, a good nutritional state is essential prior to operation.