Ileal pedicle grafting for esophageal replacement in children

被引:19
作者
Bax, NMA
Van Renterghem, KM
机构
[1] Univ Med Ctr, Wilhelmina Childrens Hosp, Dept Pediat Surg, NL-3508 AB Utrecht, Netherlands
[2] Ghent Univ Hosp, Dept Pediat Surg, B-9000 Ghent, Belgium
关键词
esophageal atresia; TEF; long gap; esophageal replacement; ileal interposition;
D O I
10.1007/s00383-005-1433-6
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Reconstruction of the upper esophagus in small children remains a challenge. Free jejunal interposition as frequently used in adults is much less appropriate in children because of the limited vessel size. The use of a jejunal pedicle graft in children has been described, but gaining enough length may be a problem. A pedicle graft of terminal ileum may be a better option, but this technique has never been described. We report a child with esophageal atresia and distal fistula who had a very short upper esophageal pouch. Primary repair was impossible. The fistula was ligated and a gastrostomy created. A second attempt at anastomosis was not successful either, and a cervical esophagostomy was created. The child was fed by gastrostomy and received sham feeding orally. When the child was 10 months old, the upper esophagus was successfully reconstructed with a pedicle graft of terminal ileum. Postoperatively there was a limited leak of the proximal anastomosis, which healed spontaneously. The distal anastomosis had to be dilated on a few occasions. With a follow-up of 1 year, the child is eating well without gastrostomy supplementation. On imaging, the ileal pedicle graft looks somewhat tortuous but contracts nicely. We feel that ileal pedicle graft reconstruction of the esophagus should be part of the instrumentarium of pediatric surgeons dealing with esophageal reconstruction.
引用
收藏
页码:369 / 372
页数:4
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