Gastric transposition for esophageal replacement in children - An Indian experience

Most pediatric surgeons are wary of gastric transposition as a means for esophageal replacement in children, especially during infancy. We present our initial experience of this technique in five children followed up for an average 1.7 years postoperatively. Four of them were infants (age range 5 m to 10 m at the time of transposition) with wide-gap esophageal atresia, white one was operated upon for an extensive corrosive esophageal stricture at 4 years age. The stomach was placed transhiatally in 3 patients and through the retrosternal route in 2 patients. A gastric outlet drainage procedure was performed in all cases. The average age at transposition in the 4 infants with esophageal atresia was 8.5 months and the mean weight was 7.4 kg. Three of the four infants required postoperative ventilation (mean duration 40 hours) and the average duration of hospital stay was 24 days. Our first transposition in a chubby infant resulted in death (20% mortality for this series) due to difficult ventilation. Other complications included anastomotic leak and subsequent stricture (one patient), adhesive obstruction (one patient), transient Horner's syndrome and recurrent laryngeal nerve palsy (one patient), and poor weight gain (one patient). Postoperatively, while the pattern of liquid gastric emptying was variable, no duodenogastric reflux was demonstrable. Thus gastric transposition is a safe, relatively simple and physiologic procedure in infancy and childhood and has given good functional results.