Gastric Tube Replacement in Esophageal Atresia

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Gastric Tube Replacement in Esophageal Atresia

Chang-Sup Lim, M.D., Hyuu-Young Kim, M.D., Kwi-Won Park, M.D., Sung-Eun Jung, M.D., Seong-Cheol Lee, M.D., Woo-Ki Kim, M.D.

Department of Surgery, Seoul National University College of Medicine Seoul, Korea

The history of esophageal replacement in infants or children is the history of development of various kinds of alternative conduits such as stomach, colon, and small bowel. The gastric tube has been the most widely used conduit. From January 1988 to May 2003, 23 esophageal replacements with gastric tube were performed at the Department of Pediatric Surgery, Seoul National University Childrens Hospital. Statistical analysis was performed using Windows SPSSl1.0 Pearson exact test. There were Gross type A(n=10), type B(n=l), type C(n=ll), type D(n=l). Ten patients who had long gap esophageal atresia (type A-8, type B-1, type C-l) and 13 patients (type A 2, type C-I0, type D-l) who had stenosis, leakage, recurred tracheoesophageal fistula, and esophagocutaneous fistula after previous corrective operations, had esophageal replacement with gastric tube.

Mean follow-up periods were 4 year 2 months (7 months-15 year 1 month). There were postoperative complications including GERD in 16 (69.6

%),

leakages in 7 (30.4

%),

diverticulum at anastomosis in 2 (8.7

%),

anastomosis site stenosis in 4 07.3

%),

and distal stenosis of the gastric tube in 1 (4.3

%).

There was no statistical signifi- cance between operation types and postoperative leakage and gastroesophageal reflux. In conclusion, esophageal replacement with gastric tube may be a useful surgical option in esophageal atresia with long gap and esophageal atresia complicated by previous corrective operation.

(J Kor Assoc

Pedi~tr

Surg 10(2):92-98), 2004_

Index Words: Esopmgeal atresia; Gastric tube; Esopmgeal replacement

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Table 1. Indication of Esophageal Replacement

Number of patients Primary gastric tube replacement 10

Secondary gastric tube replacement 13

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A (8), 8 (1), C (1) * Long gap

A (2), C (10), D (1) * Anastomosis site leakage Anastomosis site stenosis

Recurred tracheoesophageal fistula

*: Number in parenthesis is number of patients according to type

Table 2. Gastric Tube Replacement of Type C Patients No of

Primary operation Additional operation Status at Cause of Esophageal Gastric tube

Patients presentation replacement Replacemant

1-3 TEF ligation & Long gap AM

gastrostomy

TEF ligation & E-E anastomosis Recurred TEF Severe adhesion* 1M Stent insertion & Stenosis

Remnant esophagectomy esophagostomy & gastrostomy

TEF ligation & E-E anastomosis Recurred TEF Severe adhesion* 1M Esophagostomy

Distal, proximal esophagus ligation

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& E-E anastomosis

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& E-E anastomosis

10-11 TEF ligation Anastomosis Severe adhesion* AM

& E-E anastomosis leakage

Gastrostomy Anastomosis Severe adhesion* IR

leakage

Abbreviations: TEF, tracheoesophageal fistula; E-E anastomosis, esophagus-esophagus end to end anastomosis; AM, antiperistaltic-mediatinum; 1M, isoperistaltic-mediastinum; AR, antiperistaltic- retrosternal; IR, isoperistaltic-retrosternal

* : difficult dissection of original esophagus because of severe adhesion

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Operative type Number of patients Leakage GERD

Intrathoracic route Mediastinum Retrosternum

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GERD: gastro-esophageal reflux disorder

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