Colonic interposition.

Intrathoracic colonic interposition in children with esophageal atresia has been used for the past 36 years. The preferred routes have been via the left pleural cavity and retrosternally. Over the past 13 years the author has developed a method using the posterior mediastinum (normal esophageal route) for the colonic interposition. An analysis of 19 personal cases using this method is presented. A further nine cases using either the retrosternal or the Waterston routes and six cases using a modified neonatal operation are included. The evolution of the method currently used by the author is traced. Major problems remain, and further modifications relating to the optimal timing for the colonic interposition, length of colon graft, and sitting of the lower cologastric anastomosis continue to be tried and are discussed. The function of the graft has been studied with ten patients using 99Tc-labeled milk. The results of this study (unpublished) are presented. Gravity is shown to be the major factor influencing the onward passage of milk and food between the colon and stomach.