Shalaby Rafik, Shams Abdelmonaem, Soliman Soliman Mohamed, Samaha Abelhady, Ibrahim Hossam Abdelrazek
Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Pediatr Surg Int. 2007 Jun;23(6):545-9. doi: 10.1007/s00383-007-1888-8. Epub 2007 Mar 9.
A tight post-corrosive esophageal stricture in a child poses significant surgical challenges. Many studies have described minimally invasive esophagectomy in adults, but very few reports have described this technique in children. Minimally invasive esophagectomy represents a new alternative to conventional open esophagectomy. This retrospective study evaluated the safety and efficacy of laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment. Twenty-seven children with post-corrosive esophageal stricture were subjected to this technique. Their ages ranged from 3 to 13.5 years (mean 5.6 years). Fourteen were females and thirteen were males. None of the procedures needed to be converted to an open approach, and there were neither intra-operative complications nor increased blood loss. Left-sided pneumothorax occurred in one case only (3.7%). The mean operating time was 160 min (range 120-180). Three patients were admitted postoperatively to intensive care unit for a period of 48 h for assisted ventilation. Mean hospital stay was 4 days (range 3-7 days). Anastomotic leakage occurred in three patients (11.1%), while anastomotic stricture occurred in four patients (14.8%). About 93.5% of our cases have achieved excellent results. Post-operative nutritional status was satisfactory and accepted. Laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment in children is safe, visible, effective, and an accepted operative technique. The cosmetic result is excellent.
儿童腐蚀性食管狭窄术后形成的紧密狭窄给手术带来了重大挑战。许多研究描述了成人的微创食管切除术,但很少有报告描述该技术在儿童中的应用。微创食管切除术是传统开放性食管切除术的一种新替代方法。这项回顾性研究评估了腹腔镜辅助经裂孔食管切除术和胃转位术治疗腐蚀性食管狭窄的安全性和有效性。27例腐蚀性食管狭窄患儿接受了该技术治疗。他们的年龄在3至13.5岁之间(平均5.6岁)。14例为女性,13例为男性。所有手术均无需转为开放手术,术中无并发症,失血也未增加。仅1例(3.7%)发生左侧气胸。平均手术时间为160分钟(范围120 - 180分钟)。3例患者术后入住重症监护病房48小时进行辅助通气。平均住院时间为4天(范围3 - 7天)。3例患者(11.1%)发生吻合口漏,4例患者(14.8%)发生吻合口狭窄。约93.5%的病例取得了优异的效果。术后营养状况良好且可接受。腹腔镜辅助经裂孔食管切除术和胃转位术治疗儿童腐蚀性食管狭窄是安全、可视、有效的,且是一种可接受的手术技术。美容效果极佳。