RETROSTERNAL ILEOCOLIC ESOPHAGEAL REPLACEMENT IN CHILDREN REVISITED -ANTIREFLUX ROLE OF THE ILEOCECAL VALVE

The risk of postoperative reflux and pulmonary aspiration with straigh t colon or gastric tube esophageal replacement in children prompted us to reevaluate the presumed antireflux role of the ileocecal valve wit h retrosternal ileocolic interposition. This operation was done in eig ht patients with esophageal atresia (six) and lye stricture (two) from 19 to 50 months of age between 1983 and 1992. There were no operative deaths. The duration of follow-up ranged from 4 to 115 months. Barium swallow obtained in all patients showed unobstructed esophagoileocoli c transit without reflux. Two patients with esophageal atresia had loc alized proximal anastomotic leaks, which healed spontaneously without stricture. In the two patients with lye ingestion ileoesophageal stric tures developed that necessitated revision. None of the patients had p ostoperative respiratory complications or symptomatic gastroesophageal reflux. Ah eight children have had their gastrostomy tubes removed, a re eating a regular diet, and are growing well. In conclusion, the ret rosternal ileocolic conduit provides an excellent substitute esophagus in selected pediatric patients, with potential advantages over delaye d primary anastomosis or the straight colon or gastric tube interposit ion because of the antireflux role of the ileocecal valve.