title: Laparoscopically assisted esophagectomy and colon interposition for esophageal replacement in children: preliminary results of a novel technique.
abstract: BACKGROUND
  Colonic interposition is one of the surgical options in children when esophageal replacement is necessary, especially when the stomach is not suitable as a conduit. Conventional open surgery and blind mediastinal dissections present reasonable morbidity, which can be reduced by videosurgery. The authors present novel techniques and the preliminary results of the first series of laparoscopically assisted esophagectomies and colonic interpositions (LECIN) in children.
  
  
  METHODS
  Five children aged 19 months to 4 years underwent LECIN. Indications were complicated esophageal atresia and severe caustic esophagitis. The patients were operated on laparoscopically using 3 ports, including the gastrostomy site. Transhiatal esophagectomy was carried out, followed by pyloroplasty and mobilization of the transverse colon maintaining a double blood supply from the left pedicle. The stomach at the gastrostomy site was freed and closed in 3 cases. The colon was exteriorized through this 2- to 3-cm site or through the umbilicus, and the conduit was fashioned extracorporeally, including the colocolic and gastrocolic anastomosis. The colon was pulled up along the retromediastinal tunnel for the coloesophageal anastomosis through a cervical incision.
  
  
  RESULTS
  Operative times ranged from 3 to 4.3 hours; there were no conversions and no complications related to laparoscopy. There were no cardiorespiratory problems, and 4 were extubated immediately after operation. Feedings could be started by day 3 to 4. Postoperative complications included atelectasis (1), pneumonia (1), and cervical stenosis because of persistent fibrotic esophagus, requiring cervical revision (1). One needed dilatations for mild dysphagia. After a follow-up period of 10 to 29 months, all patients are asymptomatic, gaining weight, and feeding well.
  
  
  CONCLUSIONS
  These preliminary data suggest that LECIN is feasible and can be safely performed with very low morbidity in children. Further studies with larger series and follow-up are expected.
authors.affiliation: Pediatric Surgery Division, University of Goias, Goiania 74680-330, Brazil. edward@doctor.com
authors.forename: Edward
authors.initials: E
authors.lastname: Esteves
authors.forename: Humberto Barbosa
authors.initials: HB
authors.lastname: Sousa-Filho
authors.forename: Seiji
authors.initials: S
authors.lastname: Watanabe
authors.forename: José Ferreira
authors.initials: JF
authors.lastname: Silva
authors.forename: Eriberto Clemente
authors.initials: EC
authors.lastname: Neto
authors.forename: André Luiz
authors.initials: AL
authors.lastname: da Costa
mesh_terms: D002057:Burns, Chemical / Q000150:complications; D002675:Child, Preschool; D003106:Colon / Q000098:blood supply / Q000637:transplantation*; D004933:Esophageal Atresia / Q000601:surgery; D004940:Esophageal Stenosis / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004941:Esophagitis / Q000209:etiology / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures