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Esophageal replacement using the colon: a 15-year review
1Department of Pediatric Surgery, Istanbul University, Cerrahpasa Medical Faculty, Turkey.
Pediatric Surgery International
|January 10, 2001
Summary
Colonic interposition effectively serves as esophageal replacement in children. Routine additional surgeries like pyloroplasty are unnecessary, as complications are manageable and the colon remains a superior esophageal substitute.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal replacement (ER) is crucial for children with esophageal defects.
- Colonic interposition is a viable surgical option for pediatric ER.
Purpose of the Study:
- To evaluate the efficacy and complications of colonic interposition for esophageal replacement in children.
- To assess the necessity of routine adjunct procedures such as pyloroplasty or antireflux surgery.
Main Methods:
- Retrospective review of 18 children undergoing colonic interposition for ER between 1984 and 1999.
- Analysis of surgical techniques (Waterston vs. retrosternal) and patient outcomes, including early and late complications.
- Long-term follow-up data (mean 38 months) for 15 patients.
Main Results:
- 11 early cervical leaks and 2 pulmonary issues were observed; most cervical leaks healed well.
- Late complications included redundancies, gastrocolic refluxes, and anastomotic stenoses, with 6 patients requiring secondary surgery.
- Four deaths occurred, two unrelated to the colonic interposition procedure.
Conclusions:
- Colonic interposition is a highly effective esophageal substitute in pediatric patients.
- Routine pyloroplasty or antireflux surgery is not indicated alongside primary colonic interposition.
- The colon remains a preferred option for esophageal replacement due to its durability and functionality.