Résumé
Gastric transposition was performed in 100 children as a definitive procedure for oesophageal replacement between 1982 and 1997 for 69 oesophageal atresia (41 with distal tracheooesophageal fistula, 20 isolated oesophageal atresia and 8 with proximal tracheooesophageal fistula), 16 severe caustic stricture, 7 intractable peptic reflux stricture and 8 miscellaneous causes. Six mortalities were recorded. Sixty-five patients had complications postoperatively and respiratory complication was the most common complication especially in oesophageal atresia patients. Swallowing difficulty, particularly in oesophageal atresia, occurred in 21 per cent of the patients. Ten patients developed cervical leakage with spontaneous closure and 8 patients suffered from anastomosis stricture. Six jejunostomy revisions were required. Three of five pyloromyotomy obtained inadequate gastric drainage post gastric transposition and required the conversion to pyloroplasty. Because of the distinctive low major life-threatening morbidity and low mortality, we concluded that gastric transposition was a safe, easy and preferable procedure for oesophageal replacement in children.
Sujets)
Adolescent , Anastomose chirurgicale , Enfant , Enfant d'âge préscolaire , Procédures de chirurgie digestive/effets indésirables , Atrésie de l'oesophage/diagnostic , Femelle , Études de suivi , Humains , Iléum/chirurgie , Nourrisson , Jéjunum/chirurgie , Mâle , Complications postopératoires , Études rétrospectives , Estomac/chirurgie , Taux de survie , Résultat thérapeutiqueRésumé
The repair of esophageal atresia, preserving the patient's own esophagus is the surgical procedure of choice. In "long-gap" type or in "tension anastomosis" cases, anastomotic complications were known to be higher than in usual cases. From this report, postoperative elective ventilation for 5 days together with neck flexion position reduced such complications with minimal subsequent complications related to the mechanical ventilation.