title: Bloodless esophageal replacement in children with corrosive esophageal strictures--report of two cases.
abstract: BACKGROUND
  Esophageal replacement is major procedure with high risk for perioperative allogeneic blood transfusion (ABT), especially in pediatric patients due to nutritive deficiency, anemia, small body weight and blood volume. Autologous blood policy is particularly important in female children.
  
  
  METHODS
  We present treatment strategy with the aim of avoiding ABT, that have been applied in two female pediatric patients with caustic stricture of thoracic esophagus. The patients were 7 and 8 years old, with body weight 34 and 23.5 kg, respectively. Protocol was based on the stimulation of haematopoetic system with erythropoietin, iron therapy and preoperative autologous blood donation (PABD). In the first patient, with a history of previous retrosternal bypass esophagocoloplasty and extraction of necrotic colonic graft, delayed reconstruction--transhiatal subtotal esophagectomy and gastric pull-up with cervical anastomosis were performed. In the second patient, repeated ineffective dilatations of esophageal stricture were reason for retrosternal left colon interposiotion and exclusion of native esophagus.
  
  
  RESULTS
  No adverse events were attributed to preoperative blood donation period. No allogenic blood products were used during perioperative period. Both patients had uneventful postoperative course.
  
  
  CONCLUSIONS
  In specialized institutions for esophageal surgery, PABD with administration of erythropoietin and iron therapy, enable bloodless esophageal replacement, even in children.
authors.affiliation: Clinic for Digestive Disease, First Surgical Clinic, Clinical Center of Serbia, Belgrade.
authors.forename: Dragica
authors.initials: D
authors.lastname: Vucelić
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Savić
authors.forename: Dejan
authors.initials: D
authors.lastname: Stojakov
authors.forename: Predrag
authors.initials: P
authors.lastname: Sabljak
authors.forename: Brankica
authors.initials: B
authors.lastname: Nenadić
authors.forename: Ljubica
authors.initials: L
authors.lastname: Tomasević
authors.forename: Milos
authors.initials: M
authors.lastname: Bjelović
authors.forename: Ebrahimi
authors.initials: E
authors.lastname: Keramatollah
authors.forename: Bratislav
authors.initials: B
authors.lastname: Spica
authors.forename: Dejan
authors.initials: D
authors.lastname: Velicković
authors.forename: Vladimir
authors.initials: V
authors.lastname: Sljukić
authors.forename: Predrag
authors.initials: P
authors.lastname: Pesko
mesh_terms: D002057:Burns, Chemical / Q000150:complications*; D002648:Child; D003106:Colon / Q000637:transplantation; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans