Esophageal Replacement Surgery In Children - Pedsurgerydelhi

Introduction
Various conditions require esophageal replacement surgery in children. Some conditions are congenital i.e., present from the time of birth, and some others are due to trauma or injury. Various techniques are used for esophageal replacement surgery.

When Esophageal Replacement Surgery Is Required?
A healthy esophagus is required to perform various functions. It helps in the transport of food and other substances from the mouth to the stomach. It also prevents the reflux of acid and other substances back into the upper part by forming a barrier. This barrier is the lower esophageal sphincter. However, various conditions may require esophageal replacement surgery. These conditions are:

Long gap esophageal atresia: The esophagus is divided into an upper esophagus and lower esophagus. When the gap between the upper and lower esophagus is large, the condition is known as long gap esophageal atresia. This condition requires immediate medical intervention.
Caustic strictures: Caustic esophageal stricture occurs when the child accidentally ingests caustic substances such as strong alkali. This condition is not very common in the adult population.
Peptic strictures: People with severe gastroesophageal reflux disease are prone to peptic strictures. The acid reflux causes scars and narrows the esophagus.
Anastomotic strictures: When the surgery is done to repair esophageal conditions such as esophageal achalasia, it may result in anastomotic strictures like esophageal stenosis.
Tumors: The doctor may perform esophageal replacement surgery to remove the cancerous tissue or tumors.
Tracheoesophageal fistula: The trachea is the tube that assists in passing the air to the lungs. It is a part of the respiratory system. The esophagus is a part of the digestive system. In the tracheoesophageal fistula, there is a connection between these two tubes. This results in the passing of food into the lungs. It may result in aspiration.
Epidermolysis bullosa: It is a rare genetic disease that may result in blistering of mucus membrane and skin. This disease may result in esophageal strictures.
Prolong impaction: Prolonged impaction of foreign objects such as radiolucent substances may cause damage and requires esophageal replacement surgery.
Intractable achalasia: Achalasia is the disease of the muscles associated with the lower esophageal sphincter. In this condition, the patient experiences difficulty swallowing, pain in the chest, and food and fluid regurgitation.
Strictures due to HIV infections: HIV infections may result in ulcerative esophagitis, which may sometimes result in esophageal strictures.
Esophagitis due to chemotherapy: Chemotherapy may result in esophagitis that causes complications resulting in esophageal replacement.
What Are The Ideal Requirements For New Esophageal Passage?
Following are the requirements for ideal esophageal passage:

It should be easily replaced with the natural esophagus.
Does not cause any compression or respiratory problems.
Functional throughout life.
Either prevent or limit the reflux.
Helps in normal functioning such as swallowing
Does not increase the risk for malignancy.
Types Of Esophageal Replacement Surgery
There are generally four types of esophageal replacement surgery. The doctor will decide which surgery will suit you, depending upon the cause and severity of the condition.

Gastric interposition: In gastric interposition, the stomach is pulled up and connected to the upper part of the esophagus. The stomach can tolerate this pull-up because of the presence of a venous plexus and a rich network of submucosal arteries. The advantage of this technique includes the easy procedure, reduced risk of stricture, low risk of necrosis, and requires only one anastomosis. The disadvantage of this technique is that it may cause thoracic organ compression as the stomach may occupy a large area of the chest.

Gastric tube interposition: This is a highly technical and demanding procedure and is associated with postoperative complications. The surgery may be either isoperistaltic or reverse peristaltic. In this technique, the surgeon constructs the gastric tube from the greater curve of the stomach. The surgeon then connects the tube with the upper part of the esophagus. Advantages of this technique include high acid reflux and reduced size of the stomach.

Colonic interposition: It is one of the most commonly used methods for esophageal replacement. In this surgery, a part of the colon is removed and is positioned as the esophagus. The technique is relatively easy and simple and has less serious and less frequent complications.

Jejunal interposition: In this technique, the surgeon replaces the missing esophagus with a section of jejunum. This technique is generally used in redo cases. The children who have undergone surgery for esophageal achalasia repair and the surgery gets failed may undergo jejunal interposition surgery.

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