Eur J Pediatr Surg 2018; 28(01): 022-029
DOI: 10.1055/s-0037-1607041
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Outcomes of Esophageal Replacement: Gastric Pull-Up and Colonic Interposition Procedures

Catherine Jane Bradshaw
Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa
,
Keren Sloan
Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Anna Morandi
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa
,
Bhanumathi Lakshminarayanan
Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Sharon Gail Cox
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa
Department of Paediatric Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
,
Alastair J. W. Millar
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa
,
Alp Numanoglu
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa
Department of Paediatric Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
,
Kokila Lakhoo
Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
› Author Affiliations
Further Information

Publication History

20 April 2017

17 August 2017

Publication Date:
25 September 2017 (eFirst)

Abstract

Aim No consensus exists about the optimal surgical technique for esophageal replacement. This study reports the surgical outcomes for the gastric pull-up and the colonic interposition procedures.

Materials and Methods A retrospective review of children undergoing esophageal replacement surgery between January 2001 and June 2015 across four different pediatric surgery centers was conducted. Data collected included indications, epidemiology, surgical technique, complications, and outcomes. Patients were divided into group A, those that had a gastric pull-up procedure and group B, those that had a colonic interposition procedure.

Results In total, 50 patients were included; 29 in group A and 21 in group B. Indications included esophageal atresia, caustic ingestion, and infective esophageal stricture. The median age at the time of surgery was 13 months. The mean length of follow-up was 5.2 years. Three patients died giving a mortality rate of 6%; 2 in group A and 1 in group B.

In both groups, early postoperative complications included infective complications, such as wound infections, sepsis, and pneumonia (11), anastomotic leak (7), and respiratory complications (7). Late complications included adhesive bowel obstruction (2), anastomotic strictures (4), redundancy (1), and jejunostomy problems (1). Septic complications and anastomotic strictures occurred more frequently in group B. Further surgery was needed in eight patients; this was significantly higher in group B. Full oral feeding was achieved within 6 months in 91.5%.

Conclusion The gastric pull-up and colonic interposition have comparable mortality and outcomes. The colonic interposition was associated with a higher rate of early septic complications, anastomotic strictures, and need for further surgery.