EN
TÜRKÇE
Poster - 40
Colonic Interposition: A 10-year Institution Experience
A Walther, A Garrison, K Cain, A Isphording, M Adams, D von Allmen, D von Allmen
Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery
Purpose: Esophageal reconstruction in children is a challenge and no consensus exists for the best approach. Colonic interposition can provide a robust conduit to correct long defects. As patients with esophageal anomalies often have concomitant airway and pulmonary comorbidities, an interdisciplinary collaborative approach is beneficial. This study reports clinically relevant outcomes of colonic interposition in pediatric and adolescent patients.
Methods: A retrospective cohort study was performed from 2015 to 2024 of patients who underwent colonic interposition (CI) at our institution. Medical records were reviewed to extract patient demographics, clinical course, and operative outcomes.
Results: Fifty-five patients underwent CI in the study period. The mean age of patients was 46 months (range 2 months to 16.9 years). All had at least one procedure prior to CI. Thirty-seven (67%) patients had esophageal atresia and fifteen (27%) had a history of caustic ingestion. Other reasons for CI included esophageal leiomyomatosis, end-stage achalasia, and necrotizing esophagitis. Indication for surgery included recalcitrant strictures and residual long gap. Completion esophagectomy was performed by Pediatric Surgery using a transhiatal or thoracotomy approach, while the neck dissection was performed by Otolaryngology. The CI was routinely placed substernal or via the posterior mediastinum. One was placed through the left chest. Post operative complications included leak (23.6%), cervical coloesophageal anastomotic stricture (30.9%), graft loss (1.8%), and reoperation for recalcitrant stricture (1.8%). Following CI, 25% of patients were fed entirely by mouth while another 36% were fed by combination oral and enteral feeds.
Conclusions: Colonic interposition can be safely performed to reconstruct the esophagus for recalcitrant strictures or long gap esophageal atresia with good functional results and manageable complications in pediatric and adolescent patients. Long-term outcome studies are needed to further evaluate durability of the conduit and quality of life after CI.