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Poster Display - 137
Esophageal Replacement in Children: Controversies, Tips, and Technical Pearls from Experience
Muhammad Saleem
Akhtar Saeed Medical & Dental College, Lahore
Esophageal replacement remains a vital surgical option in children with long-gap esophageal atresia, intractable strictures, or caustic injuries where native esophagus preservation is unfeasible. This presentation delivers an experience-based and evidence-informed exploration of current controversies, conduit selection, technical variations, and long-term outcomes in pediatric esophageal substitution.
Conduit options including gastric transposition, colon interposition (right, left, or transverse), and jejunal grafts are reviewed in terms of their anatomical, physiological, and surgical merits. Routes—retrosternal, transhiatal, and subcutaneous—are critically compared with operative strategies, highlighting patient-tailored planning, meticulous tissue handling, and conduit vascularity assessment, including intraoperative use of ICG fluorescence.
Technical nuances for cervical esophagogastric anastomosis, minimizing conduit redundancy, avoiding torsion, and postoperative protocols (such as jejunostomy feeding, leak detection, and reflux control) are shared. The pros and cons of pyloroplasty, strategies for managing reflux, and timing of contrast studies and surveillance endoscopy are discussed in the context of long-term care.
Recent advances in minimally invasive and robotic-assisted esophageal replacement are explored, while addressing the psychosocial implications and quality-of-life issues that extend well beyond the operating room. The guiding principle remains clear: “Tension is the enemy”—both at the anastomotic site and for the operating surgeon.
Conclusion:
Esophageal replacement, when executed with precision, planning, and compassion, offers durable functional outcomes. Gastric transposition remains the preferred conduit in most scenarios. Long-term follow-up, nutritional rehabilitation, and psychosocial support are essential components of successful care.
(Note: This abstract is for Expert Talk)