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J Thorac Cardiovasc Surg 1994;107:1067-1072
© 1994 Mosby, Inc.

GENERAL THORACIC SURGERY

Retrosternal ileocolic esophageal replacement in children revisited:Antireflux role of the ileocecal valve

New Haven, Conn.

From the Section of Pediatric Surgery, Children's Hospital at Yale–New Haven, and the Yale University School of Medicine, New Haven, Conn.

Presented at the Seventy-third Annual Meeting of the New England Surgical Society, Balsams Grand Resort, Dixville Notch, N. H., September 25-27, 1992.

Received for publication May 11, 1993. Accepted for publication July 7, 1993. Address for reprints: Robert J. Touloukian, MD, Yale University, Pediatric Surgery, 333 Cedar St., P.O. Box 3333, New Haven, CT 06510-8062.

Abstract

The risk of postoperative reflux and pulmonary aspiration with straight colon or gastric tube esophageal replacement in children prompted us to reevaluate the presumed antireflux role of the ileocecal valve with retrosternal ileocolic interposition. This operation was done in eight patients with esophageal atresia (six) and lye stricture (two) from 19 to 50 months of age between 1983 and 1992. There were no operative deaths. The duration of follow-up ranged from 4 to 115 months. Barium swallow obtained in all patients showed unobstructed esophagoileocolic transit without reflux. Two patients with esophageal atresia had localized proximal anastomotic leaks, which healed spontaneously without stricture. In the two patients with lye ingestion ileoesophageal strictures developed that necessitated revision. None of the patients had postoperative respiratory complications or symptomatic gastroesophageal reflux. All eight children have had their gastrostomy tubes removed, are eating a regular diet, and are growing well. In conclusion, the retrosternal ileocolic conduit provides an excellent substitute esophagus in selected pediatric patients, with potential advantages over delayed primary anastomosis or the straight colon or gastric tube interposition because of the antireflux role of the ileocecal valve.(J THORACCARDIOVASCSURG1994;107:1067-72)

This article has been cited by other articles:

				M. von Flue, J. Metzger, and F. Harder Ileocecal Interpositional Graft as Gastric Replacement After Total Gastrectomy and Distal Esophagectomy Arch Surg, September 1, 1997; 132(9): 1038 - 1042. [Abstract] [PDF]