Esophageal replacement in children: experience with thirty-one cases.

Esophageal replacement procedures in adults are often performed for malignancy and are associated with significant morbidity and death. This article describes 31 children who underwent esophageal replacement procedures between 1970 and 1985. Diagnosis in the 18 boys and 13 girls included esophageal atresia in 23, caustic ingestion in six, and distal esophageal stricture caused by reflux in two. Replacement procedures performed included right colon isoperistaltic segments in 23 children, left colon antiperistaltic interposition in two, and gastric tube in four. Immediate complications included atelectasis (20), pneumothorax (four), and ventilator support greater than 2 days (eight). Ten patients developed leaks at the cervical anastomosis and required subsequent dilation. Seven patients had pulmonary restrictive disease caused by recurrent aspiration despite compliance with anti reflux measures. Four of these same children developed peptic ulceration before pyloroplasty. No patient who had a gastric drainage procedure as part of the initial operation has developed ulcer disease or aspiration pneumonitis. These data suggest that esophageal replacement procedures are relatively well tolerated in children with no deaths observed in this series. A gastric drainage procedure is an important adjunct in minimizing long-term morbidity. Since reflux, peptic ulceration, and pulmonary complications may occur, long-term follow-up essential.