Colonic replacement of esophagus in children

Purpose: The purpose of this study was to evaluate the indications and results of colonic replacement in children. Methods: During the last 18 years (1977-1995) 27 colonic transpositions have been carried out on 25 children due to esophageal pathologies. Their medical records have been analyzed retrospectively. Results: The major indication for esophageal replacement was caustic stricture. The procedure of choice was retrosternal without thoracotomy in 23 children, and intrathoracic with left thoracotomy in 2. The right colon was transposed in 21 patients, but in 2 of them the left colon was also used due to the flap necrosis of the right colon. Left colonic flap necrosis had also developed in one and gastric transposition was the choice of treatment as the last stage. The left colon was used primarily in 4 patients. Wound infection (11/27), cervical anastomotic leakage (8/27), cervical anastomotic stricture (7/27), mediastinitis (4/27), flap necrosis (4/27), and cologastric anastomotic strictures (2/27) were the complications. There were 5 deaths. Medium-term results were assessed as excellent in 10, good in 7 children. Two patients still require cervical anastomotic dilatations. One patient whose right colon is sitting in retrosternal area needs an oropharyngoplasty due to severe oropharyngeal stenosis. Conclusions: Colonic interposition is an operation of considerable magnitude and should be undertaken only after appropriate indications. Before operating for corrosive strictures every attempt should be made to establish patency and function of the patient's native esophagus