ESOPHAGEAL SUBSTITUTION WITH COLON - THE WATERSTON OPERATION

Twenty-three interpleural (Waterston) colon replacements of the esopha gus are reported, 21 for esophageal atresia and 2 for corrosive strict ures. Twenty patients are alive with an intact replacement; 17 are swa llowing well and 3 have some dysphagia. Two grafts were converted to r everse gastric tubes, 1 for venous infarction and the other because of -difficult vascular anatomy. One child died from disseminated intravas cular coagulation following gastroenteritis shortly after successful c ompletion of the interposition. Technical details of the operation are described. The need for replacement has been much less in recent year s because of improved surgical techniques for esophageal atresia, part icularly elective ventilation and the upper pouch flap operation. Reco gnition that corrosive and reflux strictures, if a dilatable channel c an be maintained, will improve if dilatation is persevered with for 2 years may avoid the need for replacement.