title: Interdisciplinary approach to esophageal replacement and major airway reconstruction.
abstract: OBJECTIVE
  Severe esophageal disease warranting replacement often presents with additional airway anomalies in children. Colon interposition and airway reconstruction have separately proven successful in attaining satisfactory outcomes. The aim of this study was to determine outcomes associated with an interdisciplinary approach to care of the patient with complex esophageal and airway disease.
  
  
  METHODS
  After IRB approval, a retrospective cohort study was performed spanning 2011 through 2015. Eleven patients underwent colon interposition and airway surgery. Review of medical records was performed, extracting patient demographics, clinical and operative courses and outcomes.
  
  
  RESULTS
  The mean age of patients was 44months (range 2-108). 91% (n=10) were transferred to our institution with primary diagnoses of caustic ingestion (45%, n=5), long gap esophageal atresia (27% n=3), tracheoesophageal fistula (18%, n=2) and necrotizing pharyngitis (9% n=1). All patients had associated airway anomalies. Pulmonology, gastroenterology and speech therapy were involved in preoperative evaluation and postoperative care of all patients. Intraoperatively, a multi-team approach was utilized. The most common postoperative complication was esophageal stricture (54%, n=6). All patients are capable of taking some to full nutrition per orum.
  
  
  CONCLUSIONS
  Colonic interposition with major airway reconstruction at our institution attains satisfactory functional results through utilization of a multidisciplinary approach.
authors.affiliation: Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
authors.forename: Inna
authors.initials: I
authors.lastname: Lobeck
authors.affiliation: Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
authors.forename: Phylicia
authors.initials: P
authors.lastname: Dupree
authors.affiliation: Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stoops
authors.affiliation: Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcon
authors.affiliation: Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Rutter
authors.affiliation: Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America. Electronic address: Daniel.vonAllmen@cchmc.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: von Allmen
mesh_terms: D002057:Burns, Chemical / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery* / Q000637:transplantation*; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000209:etiology; D004947:Esophagus / Q000002:abnormalities / Q000293:injuries; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010612:Pharyngitis / Q000139:chemically induced; D011183:Postoperative Complications; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000601:surgery*
keywords: Airway reconstruction; Caustic injury; Colon interposition; Esophageal atresia; Esophageal replacement; Tracheo-esophageal fistula