Esophageal replacement by gastric transposition: a single surgeon's experiences from a tertiary pediatric surgical center

Abstract

Background: many pediatric surgeons have limited experience of esophageal replacement. This study reports outcomes of esophageal replacement by gastric transposition performed by a single UK-based pediatric surgeon.

Methods: consecutive patients were identified who underwent esophageal replacement by gastric transposition over a 28 year period. Clinical and demographic data were collected. Weight-for-age Zscores were calculated for esophageal atresia patients.

Results: nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n=17; 10 with tracheo-esophageal fistula). At surgery, median age was 8.5 months (range 2-55), median weight was 7.4kg (range 4.0-17.4kg). A right-sided thoracotomy or trans-hiatal approach was used. Median post-operative length of stay was 17.5 days (range 7-130), median intensive care stay wasthree days (range 1- 63). There were no deaths. Anastomotic leak rate at 30 days was 10.5% (n=2). One patient required early stricture dilatation. Median weight-for-age Z-score increased from -2.17 at one year of age to -1.86, -1.70 and -1.93 at 5, 10 and 15 years.

Conclusions: esophageal replacement by gastric transposition offers a potentially life-changing treatment however is associated with significant morbidity. The majority of patients eventually achieve full oral feeding and maintenance of weight gain trajectory. A right-sided approach to the esophagus is feasible.

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Identifiers

ORCID for Nigel Hall: orcid.org/0000-0001-8570-9374

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