Substituição esofágica em crianças - 27 anos de experiência em um Hospital Universitário
Esophageal replacement in children - 27 years of experience in a University Hospital
Flavia Garcia Frogeri; Joaquim Bustorff -Silva; Antonio Gonçalves de Oliveira Filho; Marcia Alessandra Cavalaro Pereira-da Silva; Thalita Mendes Mitsunaga; Luisa Sarti
Resumo
Introdução: a substituição esofágica em crianças está indicada quando não é possível manter o esôfago nativo, o que inclui principalmente pacientes com atresia esofágica e estenose cáustica esofágica. O objetivo deste trabalho é relatar a experiência de um serviço universitário com duas técnicas de substituição esofágica, a transposição gástrica e a esofagocoloplastia.
Métodos: Estudo retrospectivo baseado na revisão de arquivos hospitalares. A população do estudo foi de 30 pacientes com idade entre 6 meses e quatorze anos, submetidos à substituição esofágica, no período de 1995 a 2022, no Hospital de Clínicas da Universidade Estadual de Campinas. Os dados analisados foram idade, sexo, doença de base, aspectos técnicos, complicações e resultados a longo prazo.
Resultados: As doenças de base mais comuns foram atresia de esôfago (73,33%) e estenose cáustica (26,67%). Vinte e um pacientes foram submetidos à transposição gástrica (70%) e nove à esofagocoloplastia (30%). A complicação pós-operatória mais frequente foi fístula da anastomose proximal, que ocorreu em 14 pacientes. A maioria dos pacientes com fístula teve recuperação espontânea. Houve três mortes no total. Dos 27 sobreviventes, 24 conseguem se alimentar exclusivamente por via oral.
Conclusão: A substituição esofágica em crianças é um procedimento com alta morbimortalidade. Esofagocoloplastia e transposição gástrica têm resultados e complicações semelhantes, com exceção de fístulas da anastomose proximal, que são em geral auto-resolutivas e mais comuns na esofagocoloplastia. A escolha da melhor técnica cirúrgica deve ser individualizada, sendo que ambas as técnicas oferecem a capacidade de alimentação via oral a curto ou médio prazo.
Palavras-chave
Abstract
Introduction: esophageal replacement in children is indicated when it is impossible to maintain the native esophagus, which in the pediatric population includes patients with esophageal atresia and esophageal caustic stenosis. The objective of this communication is to report the experience of a university service with two techniques of esophageal replacement.
Methods: this is a retrospective study based on the revision of hospital files. The study population consisted of patients who underwent esophageal replacement from 1995 to 2022, at the Hospital de Clínicas of the State University of Campinas. The analyzed data were age, sex, underlying disease, technical aspects, complications, and long-term results.
Results: during the study period, 30 patients underwent esophageal replacement. The most common underlying diseases were esophageal atresia (73.33%) and caustic stenosis (26.67%). Twenty-one patients underwent gastric transposition (70%), and nine underwent esophagocoloplasty (30%). The most frequent postoperative complication was fistula of the proximal anastomosis, which occurred in 14 patients. Most of the patients with fistulas had a spontaneous recovery. There were three deaths. Of the 27 survivors, 24 can feed exclusively by mouth.
Conclusion: esophageal replacement in children is a procedure with high morbidity and mortality. Esophagocoloplasty and gastric transposition have similar results and complications, with the exception of proximal anastomotic fistulas, which are generally self-resolving and are more common in esophagocoloplasty. The choice of the best surgical technique must be individualized according to the patients characteristics and the surgeons experience, as both techniques offer the ability to feed orally in the short or medium term.
Keywords
Referências
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Submetido em:
02/04/2024
Aceito em:
05/05/2024
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