title: [Esophageal replacement. 12 years experience].
abstract: Esophageal replacement is a surgical procedure rarely indicated in children. It is used in esophageal atresia type I and long-gap atresia when anastomosis is not possible, corrosive strictures and other unusual causes. Type and location of the graft depend on etiology and surgeon preferences. We analyse our results of a large series of esophageal replacement.
  
  
  METHODS
  . We reviewed esophageal replacements carried out in our department between January-1992 and December-2004. We report 29 patients (15 girls and 14 boys) with ages ranging from 2 months until 14 years old (median 24 months). 11 (37.9%) had esophageal atresia type I, 7 (24.1%) long-gap esophageal atresia, 8 (27.5%) caustic esophagitis, 1 herpetic esophagitis, 1 candida esophagitis and 1 esophageal necrosis due to sclerotherapy. Colon was used for substitution in 25 cases (86.2%) and stomach in 4 (13.8%). Graft location was retromediastinal in 25 children (86.2%), retrosternal in 3 and subcutaneous in 1. Native esophagus was removed in all but 2 out of 3 retrosternal cases.
  
  
  RESULTS
  After a follow up between 7 and 145 months (median 76 months) all children have a functional graft. Actually all patients tolerate oral feeding in a satisfactory way, and have had a normal pondostatural growth. Post-operative complications were pyloric obstruction in 3 patients (10.3%), upper anastomosis stricture in 3 (10.3%), 2 (6.9%) surgical wound evisceration, 2 (6.9%) diaphragmatic hernia, 1 (3.4%) retro-mediastinal abscess and 1 (3.4%) colo-gastric emptying difficulties. Also 2 pleural effusions, 1 cervical wound abscess and 1 abdominal wound one. Re-operation was needed in 11 patients (38%) due to these adverse events. Other complications were conservatively solved: 6 (20.7%) salivary fistula, 1 intestinal suboclusion and a dumping syndrome. One girl died due to a mycotic mediastinal abscess with perforation of the aorta 11 days after surgery. Overall survival was 96.5%.
  
  
  CONCLUSIONS
  Esophageal replacement has limited indications. It allow a good functional result, with adequate oral feeding and normal growth. We believe that both colon and stomach have similar outcomes, but gastric pull-up is easier to perform. It is a major surgery whose risk of complications is higher in early post-operative time.
authors.affiliation: Departamento de Cirugía Pediátrica, Hospital Infantil Universitario La Paz, Madrid. lfavila73@hotmail.com
authors.forename: L F
authors.initials: LF
authors.lastname: Avila
authors.forename: A L
authors.initials: AL
authors.lastname: Luis
authors.forename: J L
authors.initials: JL
authors.lastname: Encinas
authors.forename: A M
authors.initials: AM
authors.lastname: Andrés
authors.forename: O
authors.initials: O
authors.lastname: Suárez
authors.forename: L
authors.initials: L
authors.lastname: Martínez
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Queizán
authors.forename: J
authors.initials: J
authors.lastname: Murcia
authors.forename: P
authors.initials: P
authors.lastname: Olivares
authors.forename: L
authors.initials: L
authors.lastname: Lassaletta
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D004935:Esophageal Diseases / Q000473:pathology / Q000601:surgery*; D004944:Esophagoplasty; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome