Esophageal Atresia

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Abdelazim, O. A. A., Five Years Experience with the Gastric Tube Esophagoplasty at Cairo University Specialized Pediatric Hospital from 2011 to 2015, , Cairo, Cairo University, 2016. Abstract

Esophageal replacement in children is indicated in cases of esophageal atresia with or without fistula, in case of long gap esophageal atresia or failed primary repair. Intractable postcorrosive esophageal stricture is considered also a major indication for replacement.

We reviewed esophageal replacement cases by gastric tube carried out in our department between 2011 and 2015. We reported 50 patients (30 boys and 20 girls) there ages ranged from 7 months to 9 years. Esophageal atresia cases were 27 while caustic esophageal stricture cases were 23. Isoperistaltic gastric tube technique was done in 45 patients while antiperistaltic (reversed) gastric tube technique was done in 5 cases. Retrosternal route was chosen in 38 patients while transhiatal route was chosen in 12 patients.

Leakage and stricture were the most common complications. We had 5 cases of mortality, which were caused mainly by chest related complications. We had excellent to good results during long term follow up in terms of weight gain, swallowing pattern, quality of life, and overall satisfaction

Gastric tube is a satisfactory surgical method for esophageal replacement in children.

Gad, M. A., W. Saleh, Y. Ezzat, and Y. Korayem, "OUTCOME OF PATIENTS REFERRED FOR RESISTANT OESOPHAGEAL STRICTURES: A SINGLE CENTER EXPERIENCE", 5th World Congress of Pediatric Surgery, Washington DC, World Federation of Associations of Pediatric Surgeons, pp. 50, 2016. Abstractabstract_schedule_wofaps.pdf

Aim of the Study :Outcome study of managing resistant post corrosive oesophageal strictures by Savary-Gilliard dilatation in patients referred to our department for oesophageal replacement after several attempts of endoscopic dilatation

Methods: Dilatation starts six weeks after patient stabilization, under general anesthesia & complete muscle relaxation, using Savary-Gilliard dilators combined with fluoroscopic imaging. After several attempts of dilatation, failed cases undergo oesophageal replacement (colon bypass or gastric tube oesophagoplasty) & complications are managed accordingly. Patients are followed up for assessment of growth, dysphagia fr quality of life by questionnaire for at least 12 months on outpatient basis.

Main Results :58 Cases were studied (male: female ratio 1:1) with mean age 3.65 years (range 0.5-13) with various stricture aetiologies (52 post corrosive ingestion, 2 traumatic injuries & 4 post anastomotic esophageal atresia). All received 149 dilatations (mean = 2.56) with 71% success rate. Failed dilatation cases received oesophageal replacement, limited stricturoplasty or secondary dilatation by Savary- Gilliard dilators. Outcome showed symptomatic relief from dysphagia in 776%, normal growth pattern & improvement in quality of life pattern.

Conclusion :Savary-Gilliard dilatation is an effective option for management of resistant oesophageal strictures to preserve the native oesophagus. It has better outcome than resorting to surgeries, which should be limited to intractable