WOFAPS 2025 8th World Congress of Pediatric Surgery

Afef Toumi ¹, Marwa Messaoud ¹, Samia Belhssan ¹, Syrine Laribi ¹, Sabrine Ben Youssef ¹, Myriam Ben Fredj ¹, Amine Ksia ¹, Mongi Mekki ¹, Sawsen Chakroun ², Maha Ben Mansour ², Mohsen Belghith ¹, Lassaad Sahnoun ¹

¹ Pediatric surgery department, Fattouma Bourguiba Hospital.
² Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Introduction:

Esophagoplasty in children represents one of the major surgical challenges, requiring a multidisciplinary approach. Currently, several alternatives exist for esophageal substitutes, each with its own advantages and disadvantages.

Objectives:

To describe our experience with esophagocoloplasty in children. To compare this technique with other esophageal replacement techniques described in the literature in terms of feasibility and outcomes in the short, medium, and long term.

Material and Methods:

We conducted a retrospective, descriptive study, including patients who underwent esophageal replacement surgery in the pediatric surgery department at Fattouma Bourguiba University Hospital in Monastir, over a period of 34 years, from January 1990 to December 2024.

Results:

48 patients were included in our study, with a mean age of 55.5 months, and a male predominance. Caustic stenosis was the main indication for esophageal replacement (84.6%), followed by esophageal atresia in 7 cases. The isoperistaltic transverse colon, pedicled on the left colic vessels, was chosen for all our patients. The graft route was the posterior mediastinum in all cases. Esophagectomy with a closed thorax was performed simultaneously by stripping in 38 patients and a thoracotomy was needed to perform the esophagectomy in only one patien. However, the native esophagus was left in place in 4 patients.

Immediate postoperative complications were dominated by pneumothorax in 67.7% of cases, followed by dysphonia in 32% of cases. Nosocomial infections and cervical fistulas were also relatively frequent complications. The morbidity rate was 69.2% and the mortality rate was 7.7%.

The main long-term complications were cervical anastomotic stenoses (6 cases) and gastrocolic reflux (8 cases). The mean follow-up was 8.4 years, with satisfactory functional outcomes in 69.4% of patients.

Conclusion:

Our experience showed that, despite its complexity and relatively high morbidity, esophagocoloplasty in children is associated with low mortality and satisfactory medium- and long-term outcomes