Results of esophagoplasty in children with corrosive strictures of esophagus
DOI:
https://doi.org/10.15574/PS.2018.58.90Keywords:
children, esophageal burns, esophagocoloplastyAbstract
Objective – to analyse the results of esophagoplasty in children with corrosive strictures of esophagus.Material and methods. In total 25 children with complications of chemical and electrochemical injuries of the esophagus were operated from February 2000 till April 2017 in the Republican Scientific and Practical Centre of Pediatric Surgery in Minsk. As a corrosive substance in 17 cases it was alkali with high pH, in one case – an acid. The electrochemical burn was caused by an active battery with a voltage of 3 V, 2 cm in diameter, swallowed and stuck in the physiologic esophageal narrowing.
Results. The indications for esophagoplasty in patients with chemical burn of the esophagus were the failure of gullet bougienage and complications during the procedure as well as esophageal wall necrosis and rejection (esophageal wall defect) with the development of mediastinitis in children with an electrochemical burn of the esophagus. As a plastic material, the part of transverse colon from the hepatic angle to colon descendens was predominantly used. The graft in 60% of patients was pulled up through the anterior mediastinum. The long-term outcomes of the esophagoplasty were studied in 22 children over a period from 6 months up to 15 years 10 months after its completion. According to the physical examination (complaints, clinical, radiological and endoscopic examinations), good outcome after the operation was observed in 14 (64%) children, satisfactory result – in 7 (32%) patients, unsatisfactory – in 1 (4%) case. There were no lethal outcomes.
Conclusions. The most dangerous complication of conservative treatment of the corrosive esophageal stricture (CES) is perforation and rupture with the development of mediastinitis. In case of the esophageal perforation, the operation of choice is an emergency separation of the esophagus with gastrostomy and cervical esophagostomy. Treatment of CES by endoscopic bougienage and dilatation should be conducted for no more than two years. Bypass esophagocoloplasty is the operation of choice for patients with CES.
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