Gastric transposition for oesophageal replacement.
Eighty-three gastric transpositions for oesophageal replacement were carried out over the 15-year period 1981-1995. The vast majority of patients underwent the replacement procedure for oesophageal atresia (OA) (56), 35 following failed or abandoned attempts at primary anastomosis, and 21 for isolated atresia. Caustic oesophageal strictures constituted the next largest group (14). The favoured method of transposition was via the posterior mediastinal route without thoracotomy (n = 50). There were 6 deaths in this series (7.2%); 12% of patients developed anastomotic leaks, all of which healed spontaneously, and 12% developed strictures that responded to dilatation/s alone. Establishing oral feeding was the most common problem, especially in infants with OA who had not been sham-fed. The majority of patients have achieved satisfactory growth at medium-term follow-up and 64% have an excellent and 24% a satisfactory outcome at follow-up of up to 14 years.
Great Ormond Street Hospital for Children, WC1N 3JH, London, UK.
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