Gastric transposition in children.

PURPOSE: To analyze the outcome in 192 children (116 males, 76 females) undergoing transposition since 1981.
METHODS: The most common indications for esophageal replacement included failed repair of different varieties of esophageal atresia (138), caustic injury (29), and peptic strictures (9). A total of 81% of the patients were referred from other hospitals (50% from other countries). Age at operation ranged from 7 days to 17 years. The gastric transposition was performed by using blunt mediastinal dissection in 98 patients, with an additional 90 patients undergoing lateral thoracotomy. The retrosternal position was used in 4 patients.
RESULTS: There were no graft failures, including those who had previously had failed gastric tube or Scharli operations. Anastomotic leaks occurred in 12% (all but one resolved spontaneously). Anastomotic stricture, requiring dilation developed in 20%. Half of these patients had previously sustained caustic esophageal injury. There were 9 deaths in the group (4.6%). One death occurred intraoperatively, 5 in the early postoperative period, and there were 3 late deaths. In over 90% of our patients, the outcome was considered good to excellent in terms of absence of swallowing difficulties or other gastrointestinal symptoms. Many children preferred to eat small frequent meals. Poor outcome was particularly associated with multiple previous attempts at esophageal salvage. There was no deterioration in the function of the gastric transposition in those patients followed for more than 10 years.
CONCLUSIONS: Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 4.6% mortality and a 12% leak rate. A total of 20% of the patients needed anastomotic dilation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with other methods of esophageal replacement.