Reoperation after esophageal replacement in childhood

Background: Esophageal replacement is associated with significant morbidity that may lead to operative interventions. This study reviews the managemen t and outcome of children who underwent reoperation after esophageal replac ement. Methods: Eighteen patients who underwent esophageal replacement from 1985 t o 1997 were reviewed retrospectively. Ten patients underwent reoperation, P atient management, perioperative morbidity, and the dietary intake at follo w-up were recorded for each patient. Results: Of the reoperated patients, 7 had esophageal atresia, 2 had causti c ingestion, and 1 had achalasia. Nine patients received a colon interposit ion, and 1 received a reverse gastric tube as the initial esophageal replac ement. Seven patients required revision of the anastomoses. Three patients required complex esophageal reconstruction: 1 underwent gastric transpositi on, 1 underwent free jejunal graft, and 1 underwent gastric transposition c ombined with free jejunal graft. Seven patients were eating well at follow- up. Two patients still required partial gastrostomy tube feeding. One patie nt died 6 months postoperatively from aspiration pneumonia. Conclusions: Esophageal replacement continues to be a challenging operation associated with significant complications. Most reoperative procedures wer e directed toward strictures and persistent fistulae. Complete graft failur e can be managed by gastric transposition or free jejunal graft. Despite th e perioperative morbidity, most patients have good functional outcome. Copy right (C) 1999 by W.B. Saunders Company.