Challenges in Pediatric Foregut Replacements: An 11-Year Single-Center Experience.

Introduction Foregut replacements are performed in the pediatric population for esophageal atresia, long-segment strictures resistant to repeated dilations, caustic injuries, and malignancy. The need for foregut replacements has declined due to advances in the management of esophageal atresia and GERD (gastroesophageal reflux disease), as well as protective devices on caustic chemical containers. However, given the technical challenges of these procedures, pediatric and general surgeons should be prepared in case a foregut replacement is required. This case series describes 10 foregut replacements performed between 2013 and 2024. Methods Case logs of a pediatric surgeon at an academic medical center were reviewed between December 2013 and December 2024. Cases involving "esophagectomy", "esophageal replacement", "ileocolonic interposition", and "gastric pull-up" were included. Patient charts and operative reports were reviewed. Results A total of 10 pediatric patients (aged eight months to 23 years) underwent foregut replacement. Most patients were female (n = 6, 60%) and Hispanic (n = 8, 80%). Esophageal atresia and caustic injury were the leading indications for surgery. Ileocolonic conduits were the most commonly used reconstruction method (n = 6, 60%). Early complications included anastomotic leaks (n = 5, 50%), infections (n = 3, 30%), and dumping syndrome (n = 1, 10%). Late complications included dysphagia (n = 7, 70%), stricture formation (n = 5, 50%), and GERD (n = 4, 40%). Conclusion Though infrequently performed, foregut replacements in the pediatric population are still required in certain pathologic cases. Our series examined 10 patients who underwent replacement over 11 years. Ileocolonic conduits were the most frequently performed reconstruction, and late complications were more common. Understanding the patient's clinical history and knowledge of conduit and route options are important for proper management.