Long-term functional results of transhiatal oesophagectomy and colonic interposition for caustic oesophageal stricture

Aim of the study: Various surgical procedures have been advocated for replacement of the scarred oesophagus in children. We report here on our experience of oesophago-coloplasty. Methods: Over a 10-year period, 100 children (62 boys, 38 girls) with intractable caustic stricture of the oesophagus underwent transhiatal oesophagectomy and left colonic interposition. Their age at the time of reconstruction ranged from 14 months to 8 years (mean 3.4 years). Results: The patients were followed up post reconstruction for a period ranging from 5 to 15 years. There were 3 deaths from respiratory failure. Stricture of the cervical oesophagocolic anastomosis occurred in 6 patients and needed repeated dilatations (in 2 patients) and surgical revision (in 4 patients). Mild redundancy of the colonic substitute in the chest was noted in five cases, but in no case there was dysphagia necessitating revision of the colonic transplant. Peptic ulcer or symptomatic gastric-colic reflux was not seen in this group of patients. All of our patients are able to swallow and eat a normal unrestricted diet, they are gaining weight and enjoying a normal life pattern. Conclusion: We conclude that isoperistaltic left colon, based on both the ascending and descending branches of the left colic vessels with simultaneous oesophagectomy utilising the transhiatal approach, is the best substitute for a scarred oesophagus in children with satisfactory long-term functional results.