title: Gastric transposition in children--a 21-year experience.
abstract: OBJECTIVE
  The purpose of this study was to analyze the outcome in 173 children (104 M, 69 F) undergoing transposition since 1981.
  
  
  METHODS
  The most common indications for esophageal replacement included failed repair of different varieties of esophageal atresia (127), caustic injury (23), and peptic strictures (8). A total of 81% of the patients were referred from other hospitals (50% from other countries). Age at operation ranged from 7 days to 17 years. The gastric transposition was performed using blunt mediastinal dissection only in 90 patients with an additional 81 patients undergoing lateral thoracotomy. The retrosternal position was used in 2 patients.
  
  
  RESULTS
  There were no graft failures including those who had previously failed gastric tube or Scharlilike operations. Anastomotic leakage occurred in 12% (all but 1 resolved spontaneously). Anastomotic stricture requiring dilatation occurred in 19.6%. Half of these patients had previous caustic esophageal injury. There were 9 deaths in the group (5.2%). One death occurred intraoperatively, 5 in the early postoperative period, and there were 3 late deaths. In more than 90% of our patients, the outcome was considered good to excellent in terms of absence of swallowing difficulties or other gastrointestinal symptoms. Many, however, preferred to eat small frequent meals. Poor outcome was particularly associated with multiple previous attempts at esophageal salvage. There was no deterioration in the function of the gastric transposition in those patients followed up for more than 10 years.
  
  
  CONCLUSIONS
  Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 5% mortality and a 12% leak rate. A total of 19.6% of the patients needed anastomotic dilatation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with alternative methods of esophageal replacement.
authors.affiliation: Great Ormond Street Hospital for Children, London England, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Spitz
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005750:Gastric Juice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome