Pediatric Surgery Division and Laboratory of Pediatric Surgery (LIM-30), University of São Paulo Medical School, São Paulo, Brazil.
Dis Esophagus. 2011 Jan;24(1):25-9. doi: 10.1111/j.1442-2050.2010.01079.x.
Esophagocoloplasty and gastric transposition are two major methods for esophageal substitution in children with esophageal atresia, and there is broad agreement that these operations should not be performed before the children start walking. However, there are some reported advantages of performing such operations in the first months of life or in the neonatal period. In this study, we compared our experience with esophageal substitution procedures performed in walking children with esophageal atresia, with the outcomes of children who had the operation before the third month of life reported in the literature. The purpose of this study was to establish if we have to wait until the children start walking before indicating the esophageal replacement procedure. From February 1978 to October 2009, 129 children with esophageal atresia underwent esophageal replacement in our hospital (99 colonic interpositions and 30 gastric transpositions). The records of these patients were reviewed for data regarding demographics, complications (leaks, graft failures, strictures, and graft torsion), and mortality and compared with those reported in the two main articles on esophageal replacement in the neonatal period or in patients less than 3 months of age. The main complication of our casuistic was cervical anastomosis leakage, which sealed spontaneously in all except in four patients. One patient of the esophagocoloplasty group developed graft necrosis and three patients in the gastric transposition group had gastric outlet obstruction, secondary to axial torsion of the stomach placed in the retrosternal space. The long-term outcome of the patients in both groups was considered good to excellent in terms of normal weight gain, absence of dysphagia, and other gastrointestinal symptoms. The comparisons of the main complications and mortality rates in walking children with esophageal substitutions performed in the first months of life showed that the incidences of cervical anastomotic leaks and graft failures were similar, but mortality rate in the first few months of life was significantly greater than that observed in our group of patients (P= 0.001). Based on the comparison of our results with those of published series, we conclude that the recommendation of performing esophagocoloplasty or total gastric transposition in children with esophageal atresia after they start walking is still valid.
食管结肠吻合和胃转位是治疗食管闭锁患儿的两种主要食管替代方法，广泛认为这些手术不应在患儿开始行走前进行。然而，也有一些报道称，在生命的头几个月或新生儿期进行这些手术有一些优势。在本研究中，我们比较了在行走的食管闭锁患儿中进行食管替代手术的经验，以及文献中报道的在生命的前 3 个月内进行手术的患儿的结果。本研究的目的是确定我们是否必须等到患儿开始行走后才指示进行食管置换手术。1978 年 2 月至 2009 年 10 月，我院 129 例食管闭锁患儿行食管替代术（99 例结肠间置术和 30 例胃转位术）。回顾这些患者的记录，以获取有关人口统计学、并发症（漏液、移植物失败、狭窄和移植物扭转）和死亡率的数据，并与文献中关于新生儿期或小于 3 个月龄患儿行食管置换术的两篇主要文章中报道的数据进行比较。本病例的主要并发症是颈部吻合口漏，除 4 例患者外，其余患者均自行愈合。食管结肠吻合组 1 例患者发生移植物坏死，胃转位组 3 例患者发生胃出口梗阻，继发于胸骨后空间内胃的轴向扭转。两组患者的长期结果均为体重正常增加、无吞咽困难和其他胃肠道症状，被认为是良好至极好的。在行走的患儿中，与在生命的头几个月进行食管置换术的患儿相比，主要并发症和死亡率的比较表明，颈部吻合口漏和移植物失败的发生率相似，但在生命的头几个月死亡率明显高于我们的患者组（P=0.001）。基于与已发表系列的比较，我们得出结论，建议在患儿开始行走后对食管闭锁患儿进行食管结肠吻合或全胃转位仍然有效。
