Razi Journal of Medical Sciences

    Background & Aim: Esophageal replacement is done for patients with long gap esophageal atresia, severe stenosis of esophagus due to gastroesophageal reflux, and burns due to chemical agents. A suitable replacement for esophagus must have the following qualities: appropriate function, no tendency to malignancy, straight direction, no gastroesophageal reflux, and fewer complications. Today gastric tube, stomach, jejenum, and colon are used for esophageal replacement and each has its own advantages and disadvantages. The appropriate time for esophageal replacement is the age of 3-6 months in the case of esophageal atresia. However, when the stenosis needs over a 12-month period for dilation or the length of the stenosis is more than 5 cm and in the case of esophageal burns due to chemical agents and esophageal reflux, replacement seems to be necessary. Patients & Method: In this retrospective study, we examined the results of different methods of esophageal replacement and their complications in Ali-Asghar Hospital from 1996 to 2004. Then the results were compared with the international scientific findings . In Ali-Asghar Hospital, 18 children were operated for esophageal replacement. Among these cases, 3 patients were severe stenosis due to esophageal burns and the others were cases of long gap esophageal atresia. Replacement was done for 15 cases by colon interposition, 2 patients by gastric replacement and one case by gastric tube procedure. The third gastric replacement was performed on complicated patients who had undergone colon interposition before. Colon can be used for esophageal replacement by two methods: isoperistaltic and antiperistaltic. The rate of complications and mortality is higher in antiperistaltic method. Anastomotic leakage and stenosis of the anastomotic line are the most common complications in esophageal replacement. The common causes of mortality are aspiration pneumonia and congenital heart disease. Results: 14 out of 18 patients were male and the rest were female. The range of age to have a replacement operation was 3.5-12 months in the case of esophageal atresia and 15-30 months in the case of GER(gastroesophageal reflux) and esophagitis. Three cases of GER and chemical esophagitis underwent two methods of surgery including gastric replacement(two cases) and gastric tube(one case). 15 cases of esophageal atresia underwent colon interposition. The colon segments used for replacement were right colon in 9, left colon in 5, and transverse colon in 1 case. Conclusion: In Ali-Asghar Children’s Hospital and most other pediatric surgery centers around the world, colon is most commonly used for esophageal replacement. This kind of replacement can be carried out by two methods named isoperistaltic and antiperistaltic. In comparison with antiperistaltic method, the isoperistaltic one is accompanied by fewer complications. However, if colon interposition fails, the best replacement is the whole stomach.