ESOPHAGOCOLOPLASTY IN CHILDREN - SURGICAL TECHNIQUE, WITH EMPHASIS ONTHE DOUBLE BLOOD-SUPPLY TO THE INTERPOSED COLON, AND RESULTS

The description of certain surgical technical modifications of pediatr ic esophagocoloplasty and their impact on morbidity and mortality rate s are presented. Seventy children, aged 12 to 120 months (mean, 52.3 /- 39.5), were divided in two groups. Group 1 (40 patients), which rep resents a historical group, underwent esophagocoloplasty by the conven tional technique. Group 2 (30 patients) had the following modification s to the operation: (1) preservation of the double blood supply to the interposed colon, based on the left colic vessels and left paracolic arcade, via the sigmoid vessels; (2) low cologastric anastomosis, perf ormed at the lowest level of the anterior antrum; (3) in cases of retr osternal transposition (25 patients), fixation of the inferior border of the liver to the diaphragm and anterior abdominal wall; and (4) com plete section of the left anterior muscles, behind the colon. Five pat ients in group 2 were supposed to undergo surgical correction of a con genital cardiac anomaly and had the colon transposed through the poste rior mediastinum, on the original esophageal bed. The incidence of gra ft necrosis, gastrocolic reflux, esophagocolic anastomotic leak, and d ysphagia are compared between the groups; the survival rates also were compared. Statistical analysis was performed using the Fisher-Yates' test, with significance set at .05. Groups 1 and 2 had the following c omplication rates, respectively tively: graft necrosis, 12.5% and 0% ( P<.05); gastrocolic reflux, 20.0% and 0% (P<.05); dysphagia, 9.5% and 0% (P<.05); and esophagocolic anastomosis leak, 28.5% and 33.3% (not s ignificant). The mortality rate was 17.5% for group 1 and 3.5% for gro up 2 (P<.05). From these data, the authors conclude that morbidity and mortality related to pediatric esophagocoloplasty can be reduced sign ificantly by the four surgical technical modifications described above . Copyright (C) 1994 by W.B. Saunders Company