Esophageal replacement with colon in children.
Between 1974 and 1994, 25 colonic interposition procedures were performed for esophageal replacement in 23 cases of esophageal atresia (EA) and 2 corrosive strictures. Nine patients had one-stage and 16 had two-stage reconstructions. The transthoracic route was used in 16 cases (64%) and the retrosternal route in 9 (36%). Average age at the time of operation in EA patients was 17 months (range 12-33), and the children with corrosive injuries were 3 and 6 years old. Mean age at follow-up was 11.8 years (2.3-20.5 years). There was no mortality in the series. One patient developed full-graft necrosis and had a gastric pull-up procedure later. One child had partial graft necrosis (3 cm at the cervical end), however, enough colon was available for reconstruction. Ten patients developed a leak from the cervical anastomosis (40%) and 7 developed a stricture at the cervical esophago-colonic anastomosis (28%). The strictures were treated by repeated esophageal dilatation, and 3 patients required revision of the anastomosis (12%). Other complications included acid reflux in 2 cases (8%), small-intestinal obstruction in 1 (4%), redundancy of the colon in 1 (4%), and chest infections in 2 (8%). Follow-up included assessment of the patient's symptoms, serial growth measurements (height and weight), and where relevant, endoscopy and a contrast swallow or meal. There was a 52% improvement in weight and height percentiles post-operatively. Each of the 19 patients who had barium swallows showed rapid transit and emptying without any significant delay or hold-up. Overall long-term results were excellent in 13 patients (52%), good in 7 (28%), and fair in 5 (20%). The colon conduit thus provides an excellent substitute esophagus in pediatric patients.
Khan
A R
AR
Department of Pediatric Surgery, University Hospital of Wales, Cardiff, UK.
Stiff
G
G
Mohammed
A R
AR
Alwafi
A
A
Ress
B I
BI
Lari
J
J
D002675:Child, Preschool; D003106:Colon / Q000637:transplantation*; D004933:Esophageal Atresia / Q000601:surgery*; D004937:Esophageal Fistula / Q000601:surgery; D004940:Esophageal Stenosis / Q000601:surgery*; D004946:Esophagostomy; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome