Twenty-one year experience with the pediatric gastric tube

From 1964 to 1985 inclusive, gastric tubes have been constructed in 36 infants and children to replace a congenitally defective esophagus or an esophagus with acquired irreparable damage. This report reviews our entire series to date covering a 21-year experience. There were 24 boys and 12 girls ranging in age from 3 months to 17 years. Twenty-two patients were operated on because of congenital esophageal defects and 14 for acquired lesions. A proximally based antiperistaltic tube was constructed in 32 instances, and a distally based isoperistaltic tube made in four. Thirty tubes were passed retrosternally, five, through the chest (four with an anastomosis) and one subcutaneously. Twenty-nine infants and children had their tube construction staged, and the remaining seven had the entire procedure done in one stage. The spleen was removed in 23 early gastric tube operations. There were 19 extratube major complications. Twenty-four gastric tube neck anastomoses leaked (66%); all but one closed spontaneously within 3 months. There were 15 esophagogastric tube neck anastomotic strictures (41%), which were dilated; nine required resection. Thirty-two of the 36 infants and children have been followed for more than 1 year. Twenty-nine are swallowing normally, one is still being dilated, and one infant still does not swallow well. Mild sacculation or tortuosity of the gastric tube has been encountered only once. Growth was slow in four until the school years. One boy had his improperly made tube eventally discarded for a colon replacement. There were three deaths (tracheostomy complication, aspiration, gastric tube ulcer hemorrhage). Despite the above problems, the eventual outcome continues to be satisfactory and satisfying. The authors continue to use the staged retrosternal gastric tube operation (with some preference for the distally based isoperistaltic tube) when replacement of the esophagus is required in the pediatric patient. It seems to have withstood the test of time rather nicely.