Colon

Esophagoplasty
in children
Dr.Vivek Gharpure
Aurangabad
Colon substitution
of esophagus
subcutaneous
substernal
behind lung
 Esophageal atresia
Corrosive stricture
Reflux esophagitis and
stricture
Malignancy
 Ms. S S
• Two year old girl with history of ingestion
of drain cleaner
• Developed dysphagia
• Was admitted with pediatrician for few
days, esophagus not intubated
• Patient had total aphagia, not swallowing
saliva
• Endoscopy done by
gastroenterologist, impassable
stricture found
• Patient received iv fluids for two
weeks
• Lost 4 kg weight in two weeks
On examination,
thin
pale,
dysphagic,
constantly spitting saliva
chest normal
dehydrated
Immediate gastrostomy done
and nutrition started
 Patient allowed to put on weight
Blood transfusions given
Barium swallow showed impassable
stricture.
Ct scan of chest confirmed findings.
Stricture at the level of arch of aorta,

Barium instilled from below did not

show a esophageal remnant in the
abdomen or chest
 Prograde dilatation impossible
Retrograde dilatation impossible
Only option

REPLACEMENT
Replacement
• Colon
• Gastric pullup
• Isoperistaltic/antiperistaltic gastric tube
• Jejunum
• Colon considered most suitable
• Waterston; because stricture inside chest
and excision of strictured esophagus
necessary to prevent malignancy
Preparation
Build hemoglobin.
Build proteins,
Bowel preparation,
Chest preparation
Procedure planning
 Left thoracoabdominal
exploration.
Left colon isolated on
ascending branch of left colic
Colon divided
Anastomosis done
Loop left wrapped in saline sponges
Chest opened
Esophagus remnant found at level
of aortic arch
Entire esophagus dissected after
retracting left lung, aorta.
Esophagus replaced by a thick cord,
no lumen.
No thorasic esophagus
Dipharagmatic hiatus made.
Colon taken to chest through
the hiatus.
Esophagocolic two layered
anastomosis with 3-0 vicryl.
Colo-gastric anastomosis on
posterior wall of stomach with
3-0 vicryl and 3-0 silk
 Chest closed over drain
Abdomen closed
Tube in esophagus for
drainage
Gastrostomy on drainage
Minor anastomotic leak in the
postoperative period.
Did not required intervention,
Settled down with drainage
and gastric washouts.
 Postoperative, able to eat
everything.
Problem of reflux of gastric
acid persists.
intermittent attacks of acid
colitis but responds to
antacids and h2 blockers
 a. d.
• Congenital esophageal atresia, no fistula
• Primary gastrostomy for feeding
• Initial plan to allow the esophagus to grow
and then attempt direct anastomosis
• Did not work as patient repeatedly
aspirated
• So esophagostomy done
Gastrostomy feeds continued
till baby weighed 7.5 kg then
replacement done.
Salivary leak
in neck
 Variation
• Esophageal anastomosis in neck
• Upper anastomosis leaked as expected
and required two dilatations.
• at the end of three weeks baby on full
oral feeds
Uncommon condition
Uncommon procedure
Thank you!
Vivek Gharpure
Children’s Surgical
Hospital
13, Pushpanagari
Aurangabad