Pediatric esophageal stenoses: Challenges and new surgical device promoting tension‑free esophageal anastomosis

Iozsa,Dan Alexandru; Spătaru,Radu-Iulian; Tomescu,Luminita Florentina; Stiru,Ovidiu; Gherghiceanu,Florentina; Furtunescu,Florentina; Radavoi,Daniel; Bacalbasa,Nicolae; Balescu,Irina; Tulin,Adrian

doi:10.3892/etm.2022.11144

Pediatric esophageal stenoses: Challenges and new surgical device promoting tension‑free esophageal anastomosis

Authors:
- Dan Alexandru Iozsa
- Radu-Iulian Spătaru
- Luminita Florentina Tomescu
- Ovidiu Stiru
- Florentina Gherghiceanu
- Florentina Furtunescu
- Daniel Radavoi
- Nicolae Bacalbasa
- Irina Balescu
- Adrian Tulin
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Affiliations: Department of Pediatric Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Interventional Radiology, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania, Department of Cardiovascular Surgery, ‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania, Department of Marketing and Medical Technology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Public Health and Management, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania, Department of Visceral Surgery, ‘Fundeni’ Center of Excellence in Translational Medicine Clinical Institute, 022328 Bucharest, Romania, Department of Surgery, ‘Ponderas’ Academic Hospital, 021188 Bucharest, Romania, Department of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Published online on: January 14, 2022 https://doi.org/10.3892/etm.2022.11144
Article Number: 220

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Abstract

Esophageal stenoses of childhood have a broad spectrum of underlying causes. Their treatment is usually minimally invasive by endoscopic means, but sometimes surgery is necessary in refractory cases. Techniques employed in the surgical treatment of esophageal strictures include resection of the stenotic esophageal segment or esophageal substitution procedures. Esophageal anastomosis has always been a challenge in pediatric surgery. Anastomosis complications are linked to anatomical, biological and technical aspects. Mechanical tension between esophageal ends is an important cause of complications including anastomotic leaks or dehiscence. Eleven cases of esophageal stenoses, surgically treated in the Pediatric Surgery Department of Emergency Clinical Hospital for Children ‘Marie S. Curie’ by a single team in 5 years, were included in the present study. The results showed that, the main causes of esophageal stenosis were represented by corrosive esophageal injury in five cases, complications of esophageal atresia repair in three cases, congenital esophageal stenosis in two cases and chemotherapy‑induced esophageal necrosis in acute lymphoblastic leukemia treatment in one case. The authors also designed and presented a device facilitating esophageal anastomosis under tension. Its principle involved temporary absorption of tension at secure points of the two esophageal pouches and reallocating it in equal amounts following anastomosis while decreasing any stretch‑related tissue trauma. In conclusion, this auxiliary tool is beneficial for esophageal anastomosis; however, the standard steps of the esophageal anastomosis procedure should still be considered when necessary.

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