Transhiatal esophagectomy in children with corrosive esophageal stricture

Abstract

Ten children with corrosive esophageal strictures were referred for esophageal replacement. The children whose ages ranged between 2 and 6 years (mean 4.1 ± 1.4 years) had transhiatal esophagectomy (THE) and immediate posterior mediastinal transposition of their isoperistaltic stomach and cervical esophagogastrostomy. No patient had a gastric drainage procedure. All patients had nasogastric tube and a cervical perianastomotic drain until full oral intake resumed. Anastomotic leakages were managed by trans-oral irrigation (TOI) and postoperative feeding w a s through jejunostomy. Postoperative elective mechanical ventilation was for between 24 and 60 hours. Pleural entries were the commonest complication and they occurred in 6 patients (60%), unilateral in 2 patients, bilateral in 4 patients. Cervical anastomotic leaks and strictures occurred in 2 patients (20%) and 3 patients (30%), respectively, and the 2 patients (20%) w h o had anastomotic leaks and stricture had associated hoarseness. Though the incidence of complications w a s high, these responded well to appropriate treatment. There was no mortality in the series. THE and esophageal replacement with isoperistaltic stomach in the posterior mediastinum is a safe and useful procedure in the management of corrosive esophageal stricture in children.