Journal of pediatric surgery · 2025
Diversion pharyngostomy: A new surgical technique to manage salivary aspiration associated with complete esophageal stenosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Fayoux Pierre, Maltezeanu Alix, Segard Baptiste, Broucqsault Helene, Sfeir Rony, Toulemonde Philippine
Аннотация
OBJECTIVE: To report a new surgical technique for pharyngostomy to divert the saliva flow in patients with chronic complete upper digestive tract occlusion.
METHODS: retrospective cases series including 17 consecutive patients referred for complete pharyngo-esophageal stenosis requiring delayed reconstruction between May 2013 and December 2023. The indication was recurrent aspiration despite continuous pharyngeal suctioning. The surgical technique involved suturing the lateral hypopharyngeal wall to the skin using a limited cervical approach. This study focused on clinical data and functional outcomes.
RESULTS: The series included 13 cases of esophageal atresia and 4 cases of caustic ingestion. The median age of the patients was 4 months. Preoperative symptoms included salivary aspiration in all patients, shock in 9 patients, and pneumonia in 12 patients. Postoperative outcomes included immediate postoperative respiratory distress in 1 patient and stenosis of the cutaneous stoma in 7 patients. Oropharyngeal suction was stopped in all patients after a median of 4 days, and feeding stimulation was introduced orally in 16 patients after postoperative day 5. After excluding patients with associated comorbidities, the median postoperative hospital stay was 8 days. After esophageal reconstruction, no pharyngeal dysphagia was observed after a mean follow-up of 47 months.
CONCLUSION: Diversion cervical pharyngostomy may be suitable for patients with complete pharyngo-esophageal stenosis requiring delayed reconstruction. This technique may help to avoid salivary aspiration, its associated respiratory complications, and the need for long-term oropharyngeal suction. It allows early oral stimulation and shortens the hospital stay.
METHODS: retrospective cases series including 17 consecutive patients referred for complete pharyngo-esophageal stenosis requiring delayed reconstruction between May 2013 and December 2023. The indication was recurrent aspiration despite continuous pharyngeal suctioning. The surgical technique involved suturing the lateral hypopharyngeal wall to the skin using a limited cervical approach. This study focused on clinical data and functional outcomes.
RESULTS: The series included 13 cases of esophageal atresia and 4 cases of caustic ingestion. The median age of the patients was 4 months. Preoperative symptoms included salivary aspiration in all patients, shock in 9 patients, and pneumonia in 12 patients. Postoperative outcomes included immediate postoperative respiratory distress in 1 patient and stenosis of the cutaneous stoma in 7 patients. Oropharyngeal suction was stopped in all patients after a median of 4 days, and feeding stimulation was introduced orally in 16 patients after postoperative day 5. After excluding patients with associated comorbidities, the median postoperative hospital stay was 8 days. After esophageal reconstruction, no pharyngeal dysphagia was observed after a mean follow-up of 47 months.
CONCLUSION: Diversion cervical pharyngostomy may be suitable for patients with complete pharyngo-esophageal stenosis requiring delayed reconstruction. This technique may help to avoid salivary aspiration, its associated respiratory complications, and the need for long-term oropharyngeal suction. It allows early oral stimulation and shortens the hospital stay.