Colonic replacement of the esophagus: towards standardization of the technique
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Nov 2019 · 1 min read
In brief
In brief
This case series describes a standardized technique for colonic esophageal replacement in children using a transverse colon flap based on left colic vessels, passed retrosternally with cervical esophageal anastomosis. A key innovation is the posterior cologastric anastomosis to prevent gastric reflux complications.
Written by the GCMD Library team from the article.
Since we have started colonic replacement of the esophagus in children, several successive modifications have led to evolution of the surgical technique aiming to decrease complications and achieve the best functional outcome. Currently, our surgical group has reached a single standardized technique that has been applied to all cases included in this report.
A colonic flap (including the transverse colon) is prepared based on the left colic vessels. The proximal end of the colonic flap is transferred upwards passing at first behind the stomach and then anteriorly through the lesser omentum to traverse the thoracic cavity via a previously prepared retrosternal tunnel. The proximal end of the colonic flap is anastomosed to the proximal esophagus in the neck (end to end anastomosis). Most specifically, the distal end of the colonic flap is anastomosed to the posterior wall of the body of the stomach in order to prevent regurgitation of gastric contents into the colonic flap.
The retro-sternal colon bypass is among the successful options to replace the esophagus in children. Adding a posterior cologastric anastomosis to the procedure greatly prevents gastric regurgitation that can be responsible for short- and long-term complications.
Level of Evidence
This is a case series with no comparison group (level IV evidence).