Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients.
BACKGROUND
Gastric pull-up has become the predominant technique for esophageal replacement because of allegedly deficient results of colon grafts. This retrospective study examines the long-term results in a large series of colonic interpositions.


METHODS
One hundred six children (median, 2.9 years; range, 0.32-15 years) had their esophagus replaced between 1965 and 2008, of which 96 had colon grafts. Those survivors who were 18 years and older were contacted and, if willing, interviewed, examined, and had their functional ability rated using the Karnofsky index.


RESULTS
Ninety-six children had undergone a colon graft, and of these, 9 (9.3%) died. There were 65 long-term survivors whose indications for surgery included caustic injury (n = 32), failed tracheoesophageal fistula repair (n = 16), pure esophageal atresia (n = 14), and others (n = 3). The graft was either retrosternal (n = 49) or mediastinal (n = 16 patients). Twelve patients were unavailable for long-term assessment. After a median follow-up of 33.3 (11-41) years, 23 (43%) of 53 individuals experienced mild symptoms of reflux; scoliosis, 12 (22%) of 53, and/or other complications, 15 (27%) of 53 required further surgery. Thirty-two patients (60%) with Karnofsky indexes of 80% or higher felt healthy, 19 (36%) had mild life-style limitations (index, 40%-80%), and 2 had indexes less than 40%. Most patients live normal lives.


CONCLUSIONS
Colon conduits restored gastrointestinal continuity with limited mortality and considerable morbidity but good functional outcome and health perception in the long-term. Our study suggests that colon grafts are no worse than gastric pull-ups in the long-term.
Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain.
Laura
L
Burgos
Saturnino
S
Barrena
Ane M
AM
Andrés
Leopoldo
L
Martínez
Francisco
F
Hernández
Pedro
P
Olivares
Luis
L
Lassaletta
Juan A
JA
Tovar
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000637:transplantation*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult