title: Surgical techniques for esophageal replacement in children.
abstract: OBJECTIVE
  Surgical techniques for esophageal replacement (ER) in children include colon interposition, gastric tube, gastric transposition, and jejunal interposition. This review evaluates the merits and demerits of each.
  
  
  METHODS
  Surgical techniques, complications, and outcome of ER are reviewed over last seven decades.
  
  
  RESULTS
  Colon interposition is the time-tested procedure with minimal and less serious complications. Long-term complications include reflux, halitosis, colonic segment dilatation, and anastomotic stricture, sometimes requiring surgical interventions especially for dilatation and reflux. Gastric tube is technically more risky, and associated with early serious complications like prolonged leak in neck or mediastinum, graft necrosis, and ischemia leading to stricture of the tube. Long-term results are good. Gastric transposition is much simpler, can be performed in emergency and in newborns. It involves a single anastomosis in the neck. Post-operative complications include gastric stasis, bile reflux, restricted growth, and decreased pulmonary functional capacity. Jejunal interposition has not been used extensively due to short mesentery but long-term results are good in expert hands.
  
  
  CONCLUSIONS
  Colon is the most preferred and safest organ for ER. Stomach is a vascular and muscular organ with lower risk of ischemia. Gastric tube is a demanding technique. Jejunum or ileum is alternative for redo cases.
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. profdkgupta@gmail.com.
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007583:Jejunum / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D013270:Stomach / Q000601:surgery
keywords: Colon interposition; Gastric pull up; Gastric tube; Jejunal interposition; Pediatric