Pediatric Surgery, Tanta University Hospital, Tanta, Egypt.
Pediatric Gastroenterology, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
J Pediatr Surg. 2023 Sep;58(9):1640-1645. doi: 10.1016/j.jpedsurg.2023.02.005. Epub 2023 Feb 15.
Reflux is one of the most common late complications after gastric tube esophageal replacement in children. Herein, we report a novel approach for safely and selectively replacing the caustic strictured thoracic esophagus with a detached reversed gastric tube (d-RGT) pedicled graft with preservation of the cardia and implementation of thoracoscopy for optimizing the mediastinal pull-through process, and its outcomes.
All children who presented to our facility with an intractable postcorrosive thoracic esophageal stricture through 2020 and 2021 were enrolled in this study. The primary operational steps were thoracoscopic esophagectomy, laparotomy for d-RGT fashioning, and cervicotomy for anastomosis after the thoracoscopically monitored mediastinal pull-through process.
Eleven children met the enrollment criteria, and their perioperative characteristics were assessed. The mean operative time was 201 min. The average duration of hospitalization was 5 days. There was no perioperative mortality. A transient cervical fistula was reported for one patient and a cervical side anastomotic stricture in another patient. A third patient developed kinking of the lower end of the d-RGT at the diaphragmatic crura level and this was treated satisfactorily by redoing the abdominal side surgery. After a mean follow-up of 8.5 months, none of the patients experienced reflux, dumping syndrome, or neoconduit redundancy.
The pattern of vascular supply of the d-RGT allowed for its total irrigation. Thoracoscopy assisted in preparing the mediastinal path for a safe and precise pull-through process. The lack of reflux seen on imaging and endoscopy in these children suggests that retaining the cardia may be beneficial.
IV.
反流是儿童胃管食管置换术后最常见的晚期并发症之一。在此，我们报告了一种新的方法，使用游离反转胃管（d-RGT）蒂移植物安全且有选择性地替换腐蚀性胸段食管，并保留贲门，实施胸腔镜以优化纵隔牵引过程及其结果。
所有 2020 年至 2021 年因腐蚀性胸段食管狭窄而就诊于我院的儿童均纳入本研究。主要手术步骤包括胸腔镜食管切除术、游离 d-RGT 成形术和经胸腔镜监测纵隔牵引后的颈段吻合术。
11 名儿童符合纳入标准，评估了其围手术期特征。手术时间平均为 201 分钟。平均住院时间为 5 天。无围手术期死亡。1 例患者出现暂时性颈瘘，另 1 例患者出现颈侧吻合口狭窄。第 3 例患者出现 d-RGT 末端在膈肌足弓水平扭曲，通过重新进行腹部手术得到满意治疗。平均随访 8.5 个月后，所有患者均未出现反流、倾倒综合征或新吻合口冗余。
d-RGT 的血管供应模式允许其完全冲洗。胸腔镜有助于为安全、精确的牵引过程准备纵隔路径。这些儿童影像学和内镜检查未见反流提示保留贲门可能有益。
IV。
