Journal of Pediatric Surgery
Volume 34, Issue 11 , Pages 1630-1632, November 1999

Reoperation after esophageal replacement in childhood☆

  • James C.Y Dunn

      Affiliations

    • Division of Pediatric, UCLA School of Medicine, Los Angeles, CA, USA
    • Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
    • Department of Surgery, Kaiser Permanante, Los Angeles, CA, USA
    • ,
  • Eric W Fonkalsrud

      Affiliations

    • Division of Pediatric, UCLA School of Medicine, Los Angeles, CA, USA
    • Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
    • Department of Surgery, Kaiser Permanante, Los Angeles, CA, USA
    • ,
  • Harry Applebaum

      Affiliations

    • Division of Pediatric, UCLA School of Medicine, Los Angeles, CA, USA
    • Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
    • Department of Surgery, Kaiser Permanante, Los Angeles, CA, USA
    • ,
  • William W Shaw

      Affiliations

    • Division of Pediatric, UCLA School of Medicine, Los Angeles, CA, USA
    • Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
    • Department of Surgery, Kaiser Permanante, Los Angeles, CA, USA
    • ,
  • James B Atkinson

      Affiliations

    • Corresponding Author InformationAddress reprint requests to James Atkinson, MD, Division of Pediatric Surgery, UCLA School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095.
    • Division of Pediatric, UCLA School of Medicine, Los Angeles, CA, USA
    • Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
    • Department of Surgery, Kaiser Permanante, Los Angeles, CA, USA

Abstract 

Background: Esophageal replacement is associated with significant morbidity that may lead to operative interventions. This study reviews the management and outcome of children who underwent reoperation after esophageal replacement.

Methods: Eighteen patients who underwent esophageal replacement from 1985 to 1997 were reviewed retrospectively. Ten patients underwent reoperation. Patient management, perioperative morbidity, and the dietary intake at follow-up were recorded for each patient.

Results: Of the reoperated patients, 7 had esophageal atresia, 2 had caustic ingestion, and 1 had achalasia. Nine patients received a colon interposition, and 1 received a reverse gastric tube as the initial esophageal replacement. Seven patients required revision of the anastomoses. Three patients required complex esophageal reconstruction: 1 underwent gastric transposition, 1 underwent free jejunal graft, and 1 underwent gastric transposition combined with free jejunal graft. Seven patients were eating well at follow-up. Two patients still required partial gastrostomy tube feeding. One patient died 6 months postoperatively from aspiration pneumonia.

Conclusions: Esophageal replacement continues to be a challenging operation associated with significant complications. Most reoperative procedures were directed toward strictures and persistent fistulae. Complete graft failure can be managed by gastric transposition or free jejunal graft. Despite the perioperative morbidity, most patients have good functional outcome.

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☆ Presented at the 32nd Annual Meeting of the Pacific Association of Pediatric Surgeons, Beijing, China, May 9–14, 1999.

PII: S0022-3468(99)90631-0

Journal of Pediatric Surgery
Volume 34, Issue 11 , Pages 1630-1632, November 1999

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