Document Detail

Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients.
MedLine Citation:
PMID:  20152348     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Gastric pull-up has become the predominant technique for esophageal replacement because of allegedly deficient results of colon grafts. This retrospective study examines the long-term results in a large series of colonic interpositions. PATIENTS AND METHOD: One hundred six children (median, 2.9 years; range, 0.32-15 years) had their esophagus replaced between 1965 and 2008, of which 96 had colon grafts. Those survivors who were 18 years and older were contacted and, if willing, interviewed, examined, and had their functional ability rated using the Karnofsky index. RESULTS: Ninety-six children had undergone a colon graft, and of these, 9 (9.3%) died. There were 65 long-term survivors whose indications for surgery included caustic injury (n = 32), failed tracheoesophageal fistula repair (n = 16), pure esophageal atresia (n = 14), and others (n = 3). The graft was either retrosternal (n = 49) or mediastinal (n = 16 patients). Twelve patients were unavailable for long-term assessment. After a median follow-up of 33.3 (11-41) years, 23 (43%) of 53 individuals experienced mild symptoms of reflux; scoliosis, 12 (22%) of 53, and/or other complications, 15 (27%) of 53 required further surgery. Thirty-two patients (60%) with Karnofsky indexes of 80% or higher felt healthy, 19 (36%) had mild life-style limitations (index, 40%-80%), and 2 had indexes less than 40%. Most patients live normal lives. CONCLUSIONS: Colon conduits restored gastrointestinal continuity with limited mortality and considerable morbidity but good functional outcome and health perception in the long-term. Our study suggests that colon grafts are no worse than gastric pull-ups in the long-term.
Laura Burgos; Saturnino Barrena; Ane M Andr?s; Leopoldo Mart?nez; Francisco Hern?ndez; Pedro Olivares; Luis Lassaletta; Juan A Tovar
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  45     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  341-5     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain.
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MeSH Terms
Anastomosis, Surgical / methods
Child, Preschool
Colon / transplantation*
Digestive System Surgical Procedures / methods*
Disease-Free Survival
Esophageal Atresia / surgery*
Esophagoplasty / methods
Esophagus / surgery
Karnofsky Performance Status / statistics & numerical data
Longitudinal Studies
Quality of Life
Retrospective Studies
Trachea / surgery
Tracheoesophageal Fistula / surgery
Treatment Outcome
Young Adult

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