Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center
| Autor: | Wagner de Castro Andrade, João Gilberto Maksoud, Uenis Tannuri, Ana Cristina Aoun Tannuri, João Gilberto Maksoud-Filho |
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| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Adolescent Colon medicine.medical_treatment Dehiscence Anastomosis Esophageal Diseases Single Center medicine Humans Thoracotomy Child Digestive System Surgical Procedures Retrospective Studies Gastric emptying business.industry Stomach Anastomosis Surgical Infant Newborn Transverse colon Infant General Medicine medicine.disease Surgery medicine.anatomical_structure Child Preschool Atresia Pediatrics Perinatology and Child Health business |
| Zdroj: | Journal of Pediatric Surgery. 42:500-504 |
| ISSN: | 0022-3468 |
| Popis: | Background/Purpose Esophagocoloplasty and gastric transposition are 2 major methods of esophageal substitution in children. The purpose of this study is to review the authors' experience with these 2 techniques and compare the complications of these operations to determine whether 1 method emerges superior to the other. Methods A total of 149 children underwent surgery: 115 children underwent esophagocoloplasty, and 34 children underwent gastric transposition. Most patients (113-75.8%) had long-gap esophageal atresia. The operative technique of esophagocoloplasty consisted of the interposition of the transverse colon maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade. Gastric transposition was performed according to classical technique. The transposition of colon and stomach was performed using blunt mediastinal dissection in all patients without thoracotomy. Complications and mortality of the 2 groups of patients were compared. These complications were classified as minor (cervical anastomosis leak, abdominal evisceration, diarrhea, strictures, and reflux to the interposed viscera) and major (necrosis of transposed viscera, dehiscence of an intra-abdominal or intrapleural suture, torsion of transposed viscera, delayed gastric emptying requiring reoperation, and cologastric anastomosis stricture). Results There were 2 graft necrosis, 1 (0.8%) in the esophagocoloplasty group and another (2.9%) in the gastric transposition group. Patients who underwent esophagocoloplasty experienced a greater incidence of minor complications ( P = .001) and less major complications in comparison with the gastric transposition group ( P = .001). All minor complications were treatable and had no consequences. No difference was noted between the 2 groups with regard to the mortality rate (0.9% and 5.9%, respectively, P > .05). Conclusions Esophagocoloplasty and gastric transposition are satisfactory means of esophageal substitution in children. Considering the incidence of major postoperative complications, esophagocoloplasty must be the first choice for esophageal replacement in children. |
| Databáze: | OpenAIRE |
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