Blunt transmediastinal total esophagectomy with simultaneous substernal colon interposition for esophageal caustic stricture in children.

The management of caustic strictures of the esophagus continues to be a challenge to the pediatric surgeon. Many of these patients develop refractory strictures and esophageal reconstruction becomes necessary. Most of the currently employed surgical techniques for this reconstruction leave the injured esophagus in situ and most surgeons have been unwilling to perform a secondary thoracotomy for removal. Many authors have suggested a vastly increased risk of development of esophageal carcinoma in the caustically injured esophagus. In the past five years, techniques for blunt transmediastinal esophagectomy have been developed for adult patients with carcinoma of the cervical region of the esophagus. The current report describes the use of these techniques in two pediatric patients for performing total esophagectomy with simultaneous substernal colon interposition, without the need for thoracotomy. With careful adherence to several technical aspects, this procedure safely allows for complete removal of the injured esophagus and alleviates the concerns of subsequent complications from this organ.