Esophageal substitution with colon — the Waterston operation

Twenty-three interpleural (Waterston) colon replacements of the esophagus are reported, 21 for esophageal atresia and 2 for corrosive strictures. Twenty patients are alive with an intact replacement; 17 are swallowing well and 3 have some dysphagia. Two grafts were converted to reverse gastric tubes, 1 for venous infarction and the other because of difficult vascular anatomy. One child died from disseminated intravascular coagulation following gastroenteritis shortly after successful completion of the interposition. Technical details of the operation are described. The need for replacement has been much less in recent years because of improved surgical techniques for esophageal atresia, particularly elective ventilation and the upper pouch flap operation. Recognition that corrosive and reflux strictures, if a dilatable channel can be maintained, will improve if dilatation is persevered with for 2 years may avoid the need for replacement.