Esophageal Replacement

Abstract

This chapter describes the surgical procedure for esophageal replacement as performed by the following approach: open, including both colon interposition and gastric tube. Indications for esophageal replacement in pediatrics include esophageal strictures, stenosis, or long-gap esophageal atresia. Conduits for the esophagus include colonic interposition, gastric tube, gastric transposition, and jejunal substitution. Colonic interposition with a vascular pedicle is the most commonly used conduit and will be described. Gastric tube will also be presented and involves the creation of a neo-esophagus from the greater curvature of the stomach with the right gastroepiploic artery as the vascular pedicle.

Alternatives to esophageal replacement include serial dilations of esophageal strictures/stenoses, delayed repair of long-gap esophageal atresia, and need for gastric/jejunal feeding. Risks of esophageal replacement include vascular insufficiency with necrosis, anastomotic stricture, leak, or ulcer, delayed gastric emptying, disordered peristalsis, and ulcers. Critical concepts for this procedure involve mobilization of the esophagus at the gastroesophageal junction with esophageal dissection in the mediastinum and connection of the dissection plane with a proximal neck incision. Both gastric and colonic conduits require mobilization and subsequent anastomosis to the cervical esophagus.