WOFAPS 2025 8th World Congress of Pediatric Surgery

Nahla Kechiche, Nouha Boukhrissa, Rachida Lamiri, Afef Toumi, Mongi Mekki, Lassaad Sahnoun

Department of Pediatric Surgery, Monastir University Hospital, Tunisia

Background: Esophageal replacement surgery (esophagoplasty) in children is a complex procedure often associated with significant postoperative complications. This study aims to highlight the immediate postoperative complications observed in a series of pediatric patients.

Methods: We reviewed immediate postoperative outcomes in a cohort of pediatric patients who underwent esophageal replacement. Complications were assessed clinically and radiologically, with appropriate interventions documented.

Results: The most common postoperative complication was pneumothorax, observed in two patients due to pleural injury. Both patients developed expiratory dyspnea a few hours after surgery. Chest X-rays revealed a bilateral pneumothorax in one case and a right-sided pneumothorax in the other, necessitating pleural drainage for one week, with favorable outcomes. Another notable complication was unilateral recurrent laryngeal nerve injury in one patient, presenting with laryngeal dyspnea three hours post-surgery. This required an emergency tracheotomy and temporary mechanical ventilation for five days; decannulation was successfully achieved after one month. A severe complication occurred in one infant with caustic esophageal stricture who underwent colonic interposition. The patient developed mediastinitis with septic shock on the first postoperative day, characterized by tachycardia, hypotension, leukocytosis (20,000/mm³), and elevated CRP (200 mg/L). Despite intensive antibiotic therapy and vasopressor support, the patient died after 10 days of intubation.

Conclusion: Immediate postoperative complications following pediatric esophageal replacement can be severe, including pneumothorax, nerve injury, and life-threatening mediastinitis. Early recognition and prompt management are essential to improve outcomes. The mean postoperative hospital stay was 20 days. Mortality in this series was limited to one patient due to mediastinitis.