Transhiatal esophagectomy in children with corrosive esophageal stricture.

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 was 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%) who had anastomotic leaks and stricture had associated hoarseness. Though the incidence of complications was 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.