Outcomes of esophageal replacement in university children's hospital in Damascus

Abstract

Background and research objective: Esophageal replacement surgery in children poses a major challenge for pediatric surgeons. It is often performed for benign causes including esophageal atresia and caustic ingestion strictures. Several techniques of esophageal replacement have been developed described, and each has its own advantages and disadvantages. We carried out this retrospective study to share our center experience of esophageal replacement.

Material and method: A retrospective study of children undergoing esophageal replacement surgery in the surgery department of the University Children's Hospital in Damascus between 1/1/2018 and 1/1/2000. The data collected included age, gender, weight, indications, surgical technique, complications and outcomes.

Results: The study included 44 children (27 males, 17 females) who underwent esophageal replacement surgery during the study period. The average age at the time of the esophageal replacement surgery was 18 months (range: 6 months - 5.5 years). Indications included esophageal atresia (36) caustic ingestion stricture (8). The colon was used in 25 cases, gastric transposition in 17 cases, and the gastric tube in two cases. The posterior mediastinal route was used in 25 cases and the retrosternal route in 19 cases.

Early postoperative complications included sepsis (pneumonia and septicemia) 12, respiratory problems (pneumothorax and pleural effusion) 11, anastomotic leak 8 and wound infection 9. Late complications included upper anastomotic stricture 7, respiratory complications 6, bowel obstruction 4 and fistula 3. Full oral feeding was achieved within 6 months in 82%. There were 9 deaths with a mortality rate of 20%.

Conclusion: the esophageal replacement is a major surgery that requires a multidisciplinary care and with a high risk of complications, especially early complications such as pulmonary infection and anastomotic leak.