[size=20px]A four-year old boy ingests lye and develops a long, severe esophageal stricture that is refractory to multiple dilations. You decide to recommend esophagectomy and esophageal replacement.

 

Which technique for esophageal replacement leads to the best outcome?

 

A gastric transposition

 

B gastric tube

 

C colon interposition

 

D jejunal interpositions

 

E the technique most familiar to the surgeon[/size]

e

e

correct

 

Esophageal replacement is a challenging situation. A meta-analysis evaluating the multiple procedure types showed similar success rates and outcomes.

 

A recent review of multiple studies suggests that the important item is the experience of the surgeon and the frequency of the operation. The best procedure choice is likely to be the one with which the surgeon is most familiar. A review of the several options shows that all are acceptable but each has a unique risk benefit profile.

 

Colon interposition (CI) is the most commonly described procedure for caustic ingestion and long gap esophageal atresia and has been used as the first choice for many years. Colons are prone to redundancy and sometimes require repeat procedures to remove the redundancy and allow proper drainage.

 

Gastric transposition (GT) has been used successfully in many centers. It has similar complication rates as CI with anastomotic strictures being common. Early in the experience of GT, stomach bloating and reflux were also common complications though their incidence has lessened over time. The advantage of GT is that there is no anastomosis in the chest, only the stomach and esophagus in the neck, and that the blood supply is excellent with graft failure being uncommon.

 

Gastric tubes have a long suture line and are prone to leaks. Reflux can be a problem with these replacements however respiratory issues are uncommon.

 

Jejunal interpositons can be supplemented with microvascular procedures that are prone to graft failure and are less commonly used.

Reference literature?

Reference literature?

 

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0033-1347915

 

https://insights.ovid.com/pubmed?pmid=12368682

1. Esophageal replacement remains a challenging operation to pediatric surgeons and required significant expertise and experience in the field. Various options available for replacing the esophagus are; colon, gastric tube, stomach, jejunum, bridge gastric tube and bridge colonic segment. The choice, however, depends upon the age of the child, the initial pathology and also the surgeon’s preference. \\Pediatric Surgery Diagnosis and Management. Edited by Devendra K Gupta. 2008/ vol 1, pp.382.