Treatment of Esophageal and Tracheal Injuries Following Disc-Battery Ingestion in Children

Background Over the past decade, there has been a significant increase in severe and fatal cases of esophageal burns caused by disc batteries. Possible complications include tracheoesophageal fistula, stenosis or perforation of the esophagus, paresis or paralysis of the larynx, aortoesophageal fistula. This is one of the most difficult problems in esophageal surgery in children. Methods From 2009 to 2021, 102 children with esophageal burns with a disc battery were treated. Of these, 57 boys (55.9%), 45 girls (44.1%). The median age at the time of the burn was 18 months (1 year 6 months). The battery exposure in the esophagus ranged from 1 hour to 6 months (Me = 6 hours). 57 children (55.9%) had complications. Tracheoesophageal fistula TEF in 31 (54.4%), esophageal stenosis in 24 (42.1%) and perforation in 4 (7%), laryngeal paresis or paralysis in 24 (42.1%). Statistical data was calculated using the StatTech v. 3.0.9 program. Results The group with complications was divided into: delayed surgery—36 (63.2%), primary radical surgery—21 (36.8%). Children with TEF (31) underwent 3 types of operations: fundoplication and gastrostomy—12 (38.7%; delayed tactics, TEF closed spontaneously in 7 children (58.3%)); TEF separation in the acute period—13 (41.9%; early postoperative complications—11 (84,6%)); tracheal plastic surgery using esophageal flap—6 patients (19.4%). Children with impaired laryngeal innervation required conservative management (n = 8), tracheostomy (n = 7), or lateralization operations (laryngoplasty with costal cartilage graft, Т-tube—7, suture lateralization—2). Conclusion Delayed surgical tactics demonstrate better results (16.7%) and good long-term results compared to the group which were underwent primary reconstruction immediately after of injuries. There were no statistically significant differences in the weight-for-age Z-score before surgery and in the long-term period, p = 0.345.