Cervical fistula in colon interposition and gastric tube esophagoplasty: a comparative study

BACKGROUND: Esophageal replacement in infants and children is mainly required to treat esophageal atresia and caustic esophageal strictures. There is no rationale about the most suitable substitute in these conditions; however, the choice of substitute depends on many factors. Various esophageal substitutes have their advantages, technical difficulties, challenges, and specific complications. Our aim in this study was to evaluate the incidence of cervical fistula with both colon interposition and gastric tube esophagoplasty. METHODS: A prospective study was conducted from January 2018 to the end of June 2019. We agreed that children older than 9 months and weighting more than 10 kg are suitable for the operation. Post corrosive intractable esophageal stricture, long gap esophageal atresia or failed primary repair were our indications for replacement in this study. RESULTS: During the study period, esophageal replacement was performed on 41 patients with male predominance. Colon interposition was performed in 21 cases. Eleven interpositions were retrosternal, while 10 were performed via the posterior mediastinal approach after esophagectomy. On the other hand, gastric tube reconstruction was done in 20 cases. Interestingly, cervical fistula was significantly higher among gastric tube group (8 vs. 2). CONCLUSIONS: The rate of cervical fistula is higher in gastric tube esophagoplasty than colon interposition; however, it was not a major problem as in most cases cervical fistulas resolved spontaneously with only conservative measures without surgical intervention.