Thoracoscopic-assisted esophagectomy and laparoscopic gastric pull-up for lye injury.
BACKGROUND
Acquired esophageal strictures in children are often the result of ingestion of caustic agents. We describe 2 children with severe esophageal strictures following lye ingestion, who successfully underwent esophagectomy and gastric pull-up utilizing combined thoracoscopic and laparoscopic techniques.


METHODS
This was a retrospective chart analysis of both patients. CASE 1: A 17-year-old female, who ingested a lye-containing substance, which lead to the need for gastrostomy and esophageal dilatations, developed an esophageal stricture. Thoracoscopic esophagectomy, laparoscopic gastric conduit creation, pyloroplasty, gastric pull-up, and esophagogastric anastomosis was performed one year later. She was tolerating a regular diet for almost 4 years following esophageal replacement when she developed a gastric ulcer with gastrobronchial fistula that required open repair via a right thoracotomy. She has since recovered and resumed her regular diet. CASE 2: A 13-month-old female who ingested a lye-based cleaner underwent tracheostomy and gastrostomy on the day of injury, and esophageal dilatations beginning 1 month later. Despite dilatations, she developed severe strictures for which at age 21 months she underwent thoracoscopic esophageal mobilization, laparoscopic creation of gastric conduit, pyloroplasty, and esophagogastric anastomosis. A right thoracotomy was necessary to negotiate the conduit safely up to the neck. She is tolerating feeds and has not developed any complications for nearly 3 years following esophageal replacement.


CONCLUSIONS
Esophagectomy and gastric pull-up for esophageal lye injuries can be accomplished utilizing a combination of thoracoscopy and laparoscopy with excellent results. Long-term follow-up is necessary to manage potential complications in these patients.
Kane
Timothy D
TD
University of Pittsburgh School of Medicine, Department of Surgery, Division Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. timothy.kane@chp.edu
Nwomeh
Benedict C
BC
Nadler
Evan P
EP
D000293:Adolescent; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics; D004106:Dilatation; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D007223:Infant; D008191:Lye / Q000009:adverse effects*; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013906:Thoracoscopy; D017211:Treatment Failure
D002424:Caustics; D008191:Lye