The surgical management of esophageal stricture in children. A century of progress.

Early in this century all procedures performed on the esophagus were accomplished through its lumen. Ingestion of caustics was common and resulted in dense strictures for which complicated and ingenious methods of dilation were advised. Because obstructions usually recurred, by-pass operations were devised with conduits of skin or segments of the gastrointestinal tract. Now, in contrast, when burns occur, intensive steroid therapy usually prevents all but localized areas of stricture. These areas, if short, can be treated with hydrostatic balloon dilation under fluoroscopic control. If longer or resistant to dilation, these strictures can be managed by incision and insertion of a colic patch with excellent long-term results. To a previous series of children who have had esophageal patch with a vascularized segment of colon, now added is an experience with a free segment of small intestine with vascular anastomosis to an artery and vein in the neck and another case of a free patch of pericardium to the esophageal stricture.