Two-stage coloesophagoplasty in children with caustic burns of the esophagus: hemodynamic basis of delayed cervical anastomosis—theory and fact

Background/Purpose: This study was carried out to survey the outcome in patients with corrosive burns of the esophagus who had undergone 2-stage coloesophagoplasty procedures. Methods: Records of 81 patients with staged cervical coloesophagostomy procedures have been reviewed. In all cases, colon was pulled through the retrosternal route in an antiperistaltic fashion. The native esophagus was left in place. After the cologastric anastomosis at the antral level, cervical anastomosis was delayed for a second stage. Complications related to the procedure, corrective interventions, and long-term results were evaluated. Results: In all patients, the retrosternal route was used for the replacement of the colon. The conduits were constructed from right colon in 20 (24.7%) and left colon in 61 (75.3%) patients. There were 3 leaks (3.7%) and 9 strictures (11%). Terminal necrosis of the cervical colonic piece occurred in 3 patients who had undergone resection of the sloughed terminal end, and all were further treated by right intrathoracic antehilar coloesophagostomies performed between the remaining parts of the transplanted colon and the upper thoracic esophagus. One of these patients had wound dehiscence with subsequent sepsis and died. Conclusions: Terminal necrosis of the graft is not related to staging of the technique, but the decreased rate of cervical anastomotic strictures seem to be directly correlated with staging of cervical anastomosis. Possibly, an ischemic anastomosis at the terminal end of the graft after extensive mobilization and retrosternal placement is avoided with a delayed anastomosis performed after full restoration of the microcirculation.