Colonic Replacement of the Oesophagus

Conclusion

We share the view of many authors, that an isoperistaltic left colon segment based on the left colic vessels is the best method of oesophageal replacement for benign caustic oesophageal strictures in children. A sufficient length is available to replace the whole oesophagus and even the lower pharynx if needed. The blood supply from the left colic vessels is robust and rarely prone to anatomic variation. The close relationship between the marginal vessels and the border of the viscus results in a straight conduit with little redundancy or tendency to kinking. The left colon seems to transmit solid food more easily than the right colon and fewer problems are associated with its removal. The colon has proved to be relatively acid-resistant, and significant ulceration in the interposed segment is unusual.

In a survey of the last 475 cases, we had five deaths related to respiratory problems. No instance of graft necrosis occurred in this series; however, three patients developed late graft stenosis, two of which were at the distal part. Both patients required surgical revision, and the third patient developed an unusual proximal stenosis that was corrected by gastric pull-up.