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

• Published in: Journal of pediatric surgery Vol. 53; no. 11; pp. 2331 - 2335
• Main Authors: Foster, Jake D, Hall, Nigel J, Keys, S Charles, Burge, David M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2018
• Subjects: Anastomotic Leak; Child, Preschool; Dilatation; Esophageal atresia; Esophageal Atresia - surgery; Female; Gastric pull-up; Gastric transposition; Hospitals, Pediatric; Humans; Infant; Male; Stomach - surgery; Tertiary Care Centers; Tracheoesophageal Fistula - surgery; Treatment Outcome; United Kingdom; Weight Gain; United Kingdom; Esophageal atresia; Gastric transposition; Gastric pull-up
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2018.05.021

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.
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 Z-scores were calculated for esophageal atresia patients.
Nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n = 17; 10 with tracheoesophageal fistula). At surgery, median age was 8.5 months (range 2–55); median weight was 7.4 kg (range 4.0–17.4 kg). A right-sided thoracotomy or transhiatal approach was used. Median postoperative length of stay was 17.5 days (range 7–130); median intensive care stay was three 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.
Esophageal replacement by gastric transposition offers a potentially life-changing treatment; however, it 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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