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Esophageal replacement with colon in children: functional results and long-term growth
Insights
Colon interposition offers good long-term function and growth in children needing esophageal replacement. This study shows excellent results in 20 of 23 patients, regardless of the cause, including caustic burns or esophageal atresia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal replacement in children is crucial for conditions like caustic burns and esophageal atresia.
- Colon interposition is a debated technique for esophageal reconstruction.
Purpose of the Study:
- To evaluate the long-term outcomes of colon interposition for esophageal replacement in pediatric patients.
- To assess functional results, growth, and complications associated with this procedure.
Main Methods:
- Retrospective analysis of 23 children undergoing colon interposition.
- Evaluation included barium swallows, clinical interviews, and questionnaires.
- Mean follow-up duration was 12.8 years.
Main Results:
- Twenty of 23 patients demonstrated excellent results.
- Major morbidities included strictures, leaks, and proximal anastomotic colon ischemia.
- Patients with esophageal atresia showed improved growth percentiles post-transplant compared to those with caustic burns.
Conclusions:
- Colon interposition provides good long-term function and promotes growth in pediatric patients requiring esophageal replacement.
- The procedure is a viable option despite potential complications, offering favorable outcomes for selected pediatric cases.
Abstract:
Twenty-three children consecutively undergoing colon interposition for esophageal replacement were evaluated with barium swallows, clinical interviews, and questionnaires. Fourteen patients underwent colon interposition because of caustic burns of the esophagus only or of the hypopharynx and esophagus. Nine children had long-segment esophageal atresia or esophageal atresia with tracheoesophageal fistula and are included in our operative group. The mean follow-up was 12.8 years for all patients. Strictures, leaks, and colon ischemia at the proximal anastomosis represent the major morbidity for the operative procedure. Analysis of growth charts reveals that patients who ingest lye tend to remain in the 50th percentile after colon transplant, while patients with esophageal atresia or tracheoesophageal fistula who had been in the 12th percentile preoperatively improved to the 33rd percentile after successful transplantation. Radiographic examinations, functional results, and growth curves demonstrated excellent results in 20 patients. Although the choice of a conduit for esophageal replacement is controversial, the surgeon can expect good long-term function and growth with the use of colon in children.