Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center.
OBJECTIVE
Esophagocoloplasty and gastric transposition are 2 major methods of esophageal substitution in children. The purpose of this study is to review the authors' experience with these 2 techniques and compare the complications of these operations to determine whether 1 method emerges superior to the other.


METHODS
A total of 149 children underwent surgery: 115 children underwent esophagocoloplasty, and 34 children underwent gastric transposition. Most patients (113-75.8%) had long-gap esophageal atresia. The operative technique of esophagocoloplasty consisted of the interposition of the transverse colon maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade. Gastric transposition was performed according to classical technique. The transposition of colon and stomach was performed using blunt mediastinal dissection in all patients without thoracotomy. Complications and mortality of the 2 groups of patients were compared. These complications were classified as minor (cervical anastomosis leak, abdominal evisceration, diarrhea, strictures, and reflux to the interposed viscera) and major (necrosis of transposed viscera, dehiscence of an intra-abdominal or intrapleural suture, torsion of transposed viscera, delayed gastric emptying requiring reoperation, and cologastric anastomosis stricture).


RESULTS
There were 2 graft necrosis, 1 (0.8%) in the esophagocoloplasty group and another (2.9%) in the gastric transposition group. Patients who underwent esophagocoloplasty experienced a greater incidence of minor complications (P = .001) and less major complications in comparison with the gastric transposition group (P = .001). All minor complications were treatable and had no consequences. No difference was noted between the 2 groups with regard to the mortality rate (0.9% and 5.9%, respectively, P > .05).


CONCLUSIONS
Esophagocoloplasty and gastric transposition are satisfactory means of esophageal substitution in children. Considering the incidence of major postoperative complications, esophagocoloplasty must be the first choice for esophageal replacement in children.
Tannuri
Uenis
U
Pediatric Surgery Division and Laboratory of Pediatric Surgery, Instituto da Criança-Hospital das Clinicas, University of São Paulo Medical School, São Paulo CEP-05403-000, Brazil. uenist@usp.br
Maksoud-Filho
João Gilberto
JG
Tannuri
Ana Cristina Aoun
AC
Andrade
Wagner
W
Maksoud
João Gilberto
JG
D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000637:transplantation*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004935:Esophageal Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013270:Stomach / Q000637:transplantation*