Esophageal Replacements in Children
Replacement of the esophagus can be used in case of malformations, injuries, or acquired conditions. The new esophagus should allow normal oral feeding, with little or no gastroesophageal reflux, and be able to work well for the lifetime of the patient. S
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Olivier Reinberg
13.1
Introduction
For historical reasons, our University Hospital has been involved for a long time in esophageal replacements: in 1907, Cesar Roux performed successfully the first total esophageal replacement on a 12-year-old child in Lausanne, Switzerland. The child suffered from caustic stenosis. It was a presternal jejunoplasty, so-called esophago-jejuno-gastrostomose, a new procedure for untreatable esophageal stenosis [1]. His patient died at 53. His pupil, Henri Vulliet, was the first one to use the colon in 1911. Since then, many surgical procedures have been used to replace the injured or abnormal esophagus. From 1966 to 1989, our Master Noël Genton did 46 esophageal replacements in children, and that was a large series at that time [1–5].
13.2
Indications for Esophageal Replacements
From 1989 to 2014, we have done 285 esophageal replacements in children aged 9 months–18 years (mean age 5.9) as first attempts. They were a majority of boys (62 %) as 95 % of our replacements were for caustic burns.
O. Reinberg Pediatric Surgery, Rochettaz 24, CH – 1009 Pully, Switzerland e-mail: [email protected]
The indications for esophageal replacements differ according to the children’s native countries. Both in low- and high-income countries, ingestion of corrosive substances, alkalis or acids, is the most common cause for esophageal replacement, to minimize the hazards of household products and laws for containers with childresistant closures. The majority of ingestions occurs in children younger than 5 years and could be preventable [6–9]. Ingestion in children older than 5 years is suspect, and, in adolescents, mainly in girls, is usually intentional with larger volumes swallowed [7]. In addition, there might be an unknown number of cases of abuse. The true prevalence of these injuries is unknown. According to the report on pediatric trauma done by the World Health Organization and the UNICEF, more than 120,000 children under 6 years old suffered caustic injuries in the United States in 2004 [6, 10]. In the pediatric group, 90 % of esophageal burns are caused by alkali substances and 10 % by acids [11]. (For more details see Chap. 16.) Other indications for esophageal replacements are uncommon. As other authors, we got involved in the treatment of isolated cases of postinfectious strictures, fungal (Candida) or viral (Herpes) [12], malformations (long congenital strictures, long duplications of the esophagus), tumors (giant leiomyoma [13]), stenosis postradiotherapy, or related to epidermolysis bullosa. We do not believe dilatations can release strictures in epidermolysis bullosa as the injury on the
© Springer International Publishing Switzerland 2017 M. Lima (ed.), Pediatric Digestive Surgery, DOI 10.1007/978-3-319-40525-4_13
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O. Reinberg
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mucosa produces the recurrence [14]. However, they are the most difficult surgeries that we had to deal with. Other authors have also reported unusual cases such as postinfectious strictures after Pseudomonas infections [15] and ingeste
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