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Esophageal replacement using the colon: a 15-year review
1Department of Pediatric Surgery, Istanbul University, Cerrahpasa Medical Faculty, Turkey.
Insights
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.
Abstract:
Colonic interposition is a treatment option in childhood when esophageal replacement (ER) is necessary. We reviewed 18 children who underwent ER by colon between 1984 and 1999. There were 5 with esophageal atresia and 13 with corrosive esophagitis; 15 had long-term follow-up (mean 38 months). Three procedures were performed by the Waterston technique and 12 by the retrosternal technique. ER was completed in a single stage in all but 1 patient. Pyloroplasty or antireflux surgery were not done routinely during colonic interposition. As early complications, we observed 11 cervical leaks and 2 pulmonary problems. As late complications, there were 4 redundancies, 3 gastrocolic refluxes, 2 cervical anastomotic stenoses, and 1 each intestinal obstruction due to adhesions, cologastric stricture, cosmetic deformity of the thorax, and bulging of the neck. Six patients with complications required secondary surgery. There were 4 deaths, 2 of them unrelated to the surgery. Cervical leakage, which was the most commonly observed problem, healed well. We believe the colon is still one of the best substitutes for the esophagus and that there is no need to perform a routine pyloroplasty or antireflux procedure as an adjunct to the primary surgery.