Risk factors and complications of esophageal colon plastic surgery in children

Introduction. The need to identify risk factors and complications of esophageal plastic surgery in children remains significant in pediatric surgery. This is due to the fact common risk factors in esophageal surgery in children to be associated with various forms of esophageal atresia in newborns, issues of choosing a transplant as a rescue strategy for chemical burns and esophageal strictures, technical difficulties in the formation of anastomoses, recurrent and refractory strictures after the restoration of esophageal atresia. The aim: to identify significant risk factors and complications of esophageal plastic surgery in children with colon. Literature was searched in Embase, PubMed, Google Scholar, and Medline databases. Indications for plastic surgery of the esophagus in children include atresia of the esophagus with diastasis, which does not allow direct esophagoesophagoanastomosis; cicatricial post-burn and peptic stenosis of the esophagus, resistant to bougie; previously unsuccessful attempts to create an artificial esophagus and other rare forms of pathology. The optimal plastic material for plastic surgery of the esophagus in children is the colon. The choice of colon graft should be flexible and based on an assessment of its blood supply, required length and location. In this case, the left sections of the colon are most often used, due to the anatomical features of the vessels of this department. Complications of colon esophageal plastic surgery are mainly associated with impaired blood supply to the transplant. The use of endoscopic methods in the reconstruction of the esophagus in children can significantly improve the results of surgical treatment of such patients with mandatory timely correction of intraoperative risk factors.

Contribution:
Shmykova A.O., Alkhasov A.B. — study concept;
Shmykova A.O., Ratnikov S.A., Portugal P.M. — collecting and processing material, writing the text;
Alkhasov A.B. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 24, 2025
Accepted: November 27, 2025
Published: December 25, 2025

1. Alkhasov A.B., Razumovsky A.Yu., Mokrushina O.G., Chundukova M.A., Gebekova S.A. Comparative analysis of results of the treatment of children with esophageal atresia after delayed esophago-esophageal anastomosis and coloesophagoplasty. Detskaya khirurgiya. 2017; 21(5): 228–33. https://elibrary.ru/zigbsv (in Russian)

2. Treccarichi G.M., Di Benedetto V., Loria G., Scuderi M.G. Long-gap esophageal atresia: is native esophagus preservation always possible? Front. Pediatr. 2024; 12: 1450378. https//doi.org/10.3389/fped.2024.1450378

3. Chen H., Chen Z.X., Shi G.Q. Risk factors and prevention and treatment methods of anastomotic stricture after esophageal atresia repair: a literature review. Pediatr Surg. Int. 2025; 41(1): 99. https//doi.org/10.1007/s00383-025-05996-x

4. Gallo G., Zwaveling S., Groen H., Van der Zee D., Hulscher J. Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur. J. Pediatr Surg. 2012; 22(6): 420–5. https//doi.org/10.1055/s-0032-1331459

5. Frogeri F.G., Bustorff-Silva J., Oliveira Filho A.G., Silva M.A.C.P., Mitsunaga T.M., Sarti L. Esophageal replacement in children – 27 years of experience in a University Hospital. Rev. Col. Bras. Cir. 2024; 51: e20243756. https//doi.org/10.1590/0100-6991e-20243756-en

6. Platt E., McNally J., Cusick E. Pedicled jejunal interposition for long gap esophageal atresia. J. Pediatr Surg. 2019; 54(8): 1557–62. https//doi.org/10.1016/j.jpedsurg.2018.10.108

7. Saleem M., Iqbal A., Ather U., Haider N., Talat N., Hashim I., et al. 14 years’ experience of esophageal replacement surgeries. Pediatr Surg. Int. 2020; 36(7): 835–41. https//doi.org/10.1007/s00383-020-04649-5

8. Léonard M., Deswysen Y., Scheers I., Thoma M., de Magnée C., Stephenne X., et al. Long-term follow-up after retrosternal ileocolic esophagoplasty in two cases of long-gap esophageal atresia: why it is still a valid option as a rescue strategy. Front. Pediatr. 2023; 11: 1300802. https//doi.org/10.3389/fped.2023.1300802

9. Liu Z., Wang A., Wang D., Zhao Y., Zhang Y., Li S., et al. Esophageal atresia with concomitant hypertrophic pyloric stenosis: a case series and literature review. BMC Pediatr. 2025; 25(1): 894. https//doi.org/10.1186/s12887-025-06248-6

10. Raffensperger J.G., Luck S.R., Reynolds M., Schwartz D. Intestinal bypass of the esophagus. J. Pediatr Surg. 1996; 31(1): 38–47. https//doi.org/10.1016/s0022-3468(96)90316-4.-6

11. Sharma S., Gupta D.K., Javed A., Agarwal A.K. Total laparoscopic esophageal bypass using a colonic conduit for corrosive-induced esophageal stricture. Surg. Endosc. 2013; 27(10): 3726–32. https//doi.org/10.1007/s00464-013-2956-x

12. Sharma S., Gupta D.K. Surgical techniques for esophageal replacement in children. Pediatr. Surg. Int. 2017; 33(5): 527–50. https://doi.org/10.1007/s00383-016-4048-1

13. Spitz L. Gastric transposition in children. Semin. Pediatr. Sur. 2009; 18(1): 30–3. https://doi.org/10.1053/j.sempedsurg.2008.10.006

14. Razumovsky A.Yu., Chumakova G.Yu.I. Plastic reconstruction of esophagus with the whole stomach in children. Detskaysa khirurgiya. 2017; 21(3): 153–57. https://elibrary.ru/ytbdur (in Russian)

15. Choudhury S.R., Yadav P.S., Khan N.A., Shah S., Debnath P.R., Kumar V., et al. Pediatric esophageal substitution by gastric pull-up and gastric tube. Indian Assoc. Pediatr. Surg. 2016; 21(3): 110–4. https://doi.org/10.4103/0971-9261.182582

16. Razumovsky A.Yu., Alkhasov A.B., Bataev S.M., Chumakova G.Yu., Zadvernyuk A.S. Esophagoplasty with stomach or colon esophagoplasty in children? Comparison of treatment outcomes. Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii. 2018; 8(4): 22–32. https://doi.org/10.30946/2219-4061-2018-8-4-22-32 https://elibrary.ru/gbvhev (in Russian)

17. Cowles R.A., Coran A.G. Gastric transposition in infants and children. Pediatr. Surg. Int. 2010; 26(12): 1129–34. https://doi.org/10.1007/s00383-010-2736-9

18. Nasher O., Hall N.J., Mehta R., El-Gohary Y., Knight M. Long-gap esophageal atresia: gastric transposition or esophageal lengthening with delayed primary anastomosis? A systematic review. Pediatr. Surg. Int. 2024; 40(1): 112. https://doi.org/10.1007/s00383-024-05695-z

19. Chen H., Chen Z.X., Shi G.Q. Risk factors and prevention and treatment methods of anastomotic stricture after esophageal atresia repair: a literature review. Pediatr. Surg. Int. 2025; 41(1): 99. https://doi.org/10.1007/s00383-025-05996-x

20. Yasuda T., Shiozaki H. Esophageal reconstruction with colon tissue. Surg. Today. 2011; 41(6): 745–53. https://doi.org/10.1007/s00595-011-4513-3

21. Yasuda T., Shiraishi O., Iwama M., Makino T., Kato H., Kimura Y. Novel esophageal reconstruction technique via transmediastinal route from posterior to anterior mediastinum after esophagectomy. J. Thorac. Cardiovasc. Surg. 2018; 156(2): 859–66. https://doi.org/10.1016/j.jtcvs.2018.03.161

22. Takeuchi M., Onoda M., Yoshida K., Iwamura M., Furutani A., Kawano K., et al. Effect of venous superdrainage on colon interposition for esophageal reconstruction. J. UOEH. 2020; 42(4): 331–4. https://doi.org/10.7888/juoeh.42.331

23. Gust L., De Lesquen H., Bouabdallah I., Brioude G., Thomas P.A., D’journo X.B. Peculiarities of intra-thoracic colon interposition-eso-coloplasty: indications, surgical management and outcomes. Ann. Transl. Med. 2018; 6(3): 41. https://doi.org/10.21037/atm.2017.06.10

24. Kesler K.A., Pillai S.T., Birdas T.J., Rieger K.M., Okereke I.C., Ceppa D., et al. “Supercharged” isoperistaltic colon interposition for long-segment esophageal reconstruction. Ann. Thorac. Surg. 2013; 95(4): 1162–9. https://doi.org/10.1016/j.athoracsur.2013.01.006

25. Briel J.W., Tamhankar A.P., Hagen J.A., DeMeester S.R., Johansson J., Choustoulakis E., et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J. Am. Coll. Surg. 2004; 198(4): 536–42. https://doi.org/10.1016/j.jamcollsurg.2003.11.026

26. Comella A., Tan Tanny S.P., Hutson J.M., Omari T.I., Teague W.J., Nataraja R.M., et al. Esophageal morbidity in patients following repair of esophageal atresia: A systematic review. J. Pediatr. Surg. 2021; 56(9): 1555–63. https://doi.org/10.1016/j.jpedsurg.2020.09.010

27. Strutynska-Karpinska M., Grabowski K., Blaszczuk J., Tabola R., Sliwa B. Postoperative complications of various types of esophagoplasty. Gastroenterologia Polska. 2009; 56(3): 245–51.

28. Chávez-Aguilar A.H., Silva-Báez H., Sánchez-Rodríguez Y.B., Esparza-Ponce C., Zatarain-Ontiveros M.Á., Barrera de León J.C. Early complications with colon esophageal substitution for children via retrosternal. Gac. Med. Mex. 2015; 151(3): 323–8.

29. Besendörfer M., Müller H., Weiss C., Wagner A., Schellerer V. André Hoerning A., et al. Association of clinical factors with postoperative complications of esophageal atresia. Pediatr. Neonatol. 2021; 62(1): 55–63. https://doi.org/10.1016/j.pedneo.2020.09.001

30. Akhparov N.N., Suleimanova S.B., Litosh V.E. Outcomes of esophagoplasty in children (a 14-year experience). Detskaya khirurgiya. 2020; 24(6): 358–62. https://doi.org/10.18821/1560-9510-2020-24-6-358-362 (in Russian)

31. Coopman S., Michaud L., Halna-Tamine M., Bonnevalle M., Bourgois B., Turck D., et al. Long-term outcome of colon interposition after esophagectomy in children. J. Pediatr. Gastroenterol. Nutr. 2008; 47(4): 458–62. https://doi.org/10.1097/MPG.0b013e31815ce55c

32. Sarafi M., Ghoroubi J., Rouzrokh M., Mohajerzadeh L., Khaleghnejad Tabari A., Ebrahimisaraj Gh., et al. The outcomes of different surgical techniques for esophageal Replacement in Children with Caustic Injury: a single center experience. Iran. J. Pediatr. Surg. 2022; 8(2): 102–22.

33. Hamza A.F., Abdelhay S., Sherif H., Hasan T., Soliman H., Kabesh A., et al. Caustic esophageal strictures in children: 30 years’ experience. J. Pediatr. Surg. 2003; 38(6): 828–33.

34. Erdoğan E., Emir H., Eroğlu E., Danişmend N., Yeker D. Esophageal replacement using the colon: a 15-year review. Pediatr. Surg. Int. 2000; 16(8): 546–9. https://doi.org/10.1007/s003830000422

35. AbouZeid A.A., Zaki A.M., Safoury H.S. Posterior cologastric anastomosis: an effective antireflux mechanism in colonic replacement of the esophagus. Ann. Thorac. Surg. 2016; 101(1): 266–73. https://doi.org/10.1016/j.athoracsur.2015.06.074

36. Esteves E., Sousa-Filho H.B., Watanabe S., Silva J.F., Neto E.C., da Costa A.L. Laparoscopically assisted esophagectomy and colon interposition for esophageal replacement in children: preliminary results of a novel technique. J. Pediatr. Surg. 2010; 45(5): 1053–60. https://doi.org/10.1016/j.jpedsurg.2010.01.013

37. Zhu S., Liu Z., Li B. The application of stay sutures in thoracoscopic esophageal repair for Type C esophageal atresia. Pediatr. Surg. Int. 2025; 41(1): 217. https://doi.org/10.1007/s00383-025-06111-w

38. Manfredi M.A. Endoscopic management of anastomotic esophageal strictures secondary to esophageal atresia. Gastrointest. Endosc. Clin N. Am. 2016; 26(1): 201–19. https://doi.org/10.1016/j.giec.2015.09.002

39. Gupta D.K., Sharma S., Arora M.K., Agarwal G., Gup M., Grover V.P. Esophageal replacement in the neonatal period in infants with esophageal atresia and tracheoesophageal fistula. J. Pediatr. Surg. 2007; 42 (9): 1471–7. https://doi.org/10.1016/j.jpedsurg.2007.04.001

40. Heitmiller R.F. Esophageal conduit necrosis. Thorac. Surg. Clin. 2006; 16(1): 11–22. https://doi.org/10.1016/j.thorsurg.2006.01.003

41. Li B., Dong J., Zou C., Zhao F., Ma T., Zhou C. Postoperative reintubation as risk factor for anastomotic stricture after congenital esophageal atresia. Pediatr. Surg. Int. 2025; 41(1): 186. https://doi.org/10.1007/s00383-025-06083-x

42. Serhal L., Gottrand F., Sfeir R., Guimber D., Devos P., Bonnevalle M., et al. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J. Pediatr. Surg. 2010; 45(7): 1459–62. https://doi.org/10.1016/j.jpedsurg.2009.11.002

43. Raitio A., Cresner R., Smith R., Jones M.O., Losty P.D. Fluoroscopic balloon dilatation for anastomotic strictures in patients with esophageal atresia: A fifteen-year single centre UK experience. J. Pediatr. Surg. 2016; 51(9): 1426–8. https://doi.org/10.1016/j.jpedsurg.2016.02.089

44. Way C., Wayne C., Grandpierre V., Harrison B.J., Travis N., Nasr A. Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr. Surg. Int. 2019; 35(11): 1167–84. https://doi.org/10.1007/s00383-019-04527-9

45. Borselle D., Gerus S., Bukowska M., Patkowski D. Birth weight and thoracoscopic approach for patients with esophageal atresia and tracheoesophageal fistula-a retrospective cohort study. Surg. Endosc. 2024; 38(9): 5076–85. https://doi.org/10.1007/s00464-024-11063-8

46. Eftekharzadeh S., Akbarzadeh A., Sabetkish N., Rostami M., Zabolian A.H., Hashemi J., et al. Esophagus tissue engineering: from decellularization to in vivo recellularization in two sites. Cell Tissue Bank. 2022; 23(2): 301–12. https://doi.org/10.1007/s10561-021-09944-6

47. Deguchi K., Zambaiti E., De Coppi P. Regenerative medicine: current research and perspective in pediatric surgery. Pediatr. Surg. Int. 2023; 39(1): 167. https://doi.org/10.1007/s00383-023-05438-6

48. Bougioukas L., Pereira L.M., Weiss M.J., Glassman L.R., Zeltsman D., Hyman K.M., et al. Esophageal reconstruction using a hypopharyngeal anastomosis – a single center experience with review of the literature. J. Cardiothorac. Surg. 2025; 20(1): 345. https://doi.org/10.1186/s13019-025-03575-8