[Esophageal replacement using the large intestine in children].

Oesophageal replacement with an interposed graft of the large intestine on a vascular pedicle between the cervical oesophagus and oesophageal stump over the diaphragm was performed in four children for Vogt's classification Type-I and II oesophageal atresia. A tracheooesophageal fistula was closed in three, and gastrostomy was established in four neonates to provide nutrition. Oesophageal replacement was performed in patients aged 2 years and 5 months to 5 years and 4 months. One girl died following oesophageal replacement for bilateral pneumonia. A non-functioning oesophageus was extirpated for corrosive oesophageal stricture with simultaneous replacement by means of colonoplasty in two boys aged 3 1/4 years and 3 1/2 years. As regards complications, a shortly persisting salivary fistula developed in the cervical anastomosis, and an abundant graft was made shorter and a fundoplication for gastrooesophageal reflux was established in the same patient. To prevent leakage of the anastomosis and its stricture, the anastomoses were constructed obliquely and sutured in two layers using thin atraumatic suture with silk thread. The patients have been on follow-up for 3 to 12 years (mean 6.5 years) after oesophageal replacement; their ability to swallow, psychosomatic development and surgical criteria were employed to evaluate the outcome as excellent in four, and good in one of the children operated on.