Gastric transposition for esophageal replacement in children.

Esophageal replacement by total gastric transposition was performed on 34 infants (32 with esophageal atresia) in the 5.5-year period from January 1981 to June 1986. There were three deaths (9%), two occurring in the early postoperative period, with the third occurring 1 year after surgery from persistent chronic respiratory problems. Fourteen infants had a totally uncomplicated course and have not required further admissions. Thirteen infants had early postoperative problems including six with delayed gastric emptying, four with anastomotic strictures requiring dilatation, and two with radiologic anastomotic leaks. Four late complications consisted of two adhesion intestinal obstructions, a perforation related to a jejunal feeding tube, and a child in whom malabsorption subsequently developed. An excellent result has been obtained in 24 infants, four doing well with only minor problems with feeding, and two are fair experiencing persisting difficulties. These results compare favorably with a large previous experience in colon interposition.