Evaluation of an antireflux procedure for colonic interposition in pediatric esophageal replacements

• Published in: Journal of pediatric surgery Vol. 46; no. 3; pp. 594 - 600
• Main Authors: Vasseur Maurer, Sabine, Estremadoyro, Vanina, Reinberg, Olivier
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2011
• Subjects: Antireflux wrap; Burns, Chemical - surgery; Child; Child, Preschool; Children; Colon - transplantation; Esophageal replacement; Esophageal Stenosis - chemically induced; Esophageal Stenosis - surgery; Esophagectomy - methods; Esophagoplasty - methods; Esophagoscopy; Gastrocolic reflux; Gastroesophageal Reflux - diagnostic imaging; Gastroesophageal Reflux - prevention & control; Humans; Pediatrics; Postoperative Complications - diagnostic imaging; Postoperative Complications - prevention & control; Radiography; Reoperation; Retrospective Studies; Surgery; Suture Techniques; Transplantation, Heterotopic; Antireflux wrap; Children; Gastrocolic reflux; Esophageal replacement
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.10.032

Abstract Background In 1989, we introduced a 1-stage procedure with orthotopic colonic transplants for esophageal stenosis. A pitfall of this procedure is frequent reflux and/or stasis in the transplants from the cologastric anastomosis. Since 1993, we have used a new antireflux wrap (ARW) using an anterior wrap technique similar to the Dor procedure but fixed to the right crus of the diaphragm. Purpose The purpose of the study was to evaluate ARWs. Method From 1993 to 2008, the records of 67 patients with an ARW were compared with 27 without ARW (either operated on before 1993 or ARW was not appropriate) after colonic transplant for caustic esophageal stenosis. Both groups otherwise underwent the same surgical procedure. Postoperative esophagograms done on postoperative day 10 were reviewed for the presence of gastrocolonic reflux and stasis in the transplant. Results The reflux rate on the initial esophagogram was reduced from 48.1% to 7.5% using ARW. The incidence of reflux on later esophagograms was 40.0% with no ARW and 21.4% with ARW. The 25% long-term rate of stasis in the colonic transplant was not increased with ARW. Conclusions A loose ARW in patients with colonic esophageal replacements reduces gastrocolic reflux without increasing the rate of stasis. In the long term, children adapt better to stasis than to reflux and are thus protected from occult inflammation.