Esophageal replacement using the colon: a 15-year review

Colonic interposition is a treatment option in childhood when esophageal re placement (ER) is necessary. We reviewed 18 children who underwent ER by co lon between 1984 and 1999. There were 5 with esophageal atresia and 13 with corrosive esophagitis; 15 had long-term follow-up (mean 38 months). Three procedures were performed by the Waterston technique and 12 by the retroste rnal technique. ER was completed in a single stage in all but 1 patient. Py loroplasty or antire-flux surgery were not done routinely during colonic in terposition. As early complications, we observed 11 cervical leaks and 2 pu lmonary problems. As late complications, there were 4 redundancies, 3 gastr ocolic refluxes, 2 cervical anastomotic stenoses, and 1 each intestinal obs truction due to adhesions, cologastric stricture, cosmetic deformity of the thorax, and bulging of the neck. Six patients with complications required secondary surgery. There were 4 deaths, 2 of them unrelated to the surgery. Cervical leakage, which was the most commonly observed problem, healed wel l. We believe the colon is still one of the best substitutes for the esopha gus and that there is no need to perform a routine pyloroplasty or antirefl ux procedure as an adjunct to the primary surgery.