**2.13 Oesophageal replacement**

Oesophageal replacement surgery is usually done for patients with OA when primary repair fails or when primary repair is impossible. Various operative procedures have been described; and the most commonly used ones are colon or ileocolon interposition, reversed (antiperistalsis) gastric tube interposition, isoperistalsis gastric tube interposition, jejunum interposition and gastric transposition (gastric pull-up) [67] (**Table 10**).

Among the methods, colon replacement, or ileocolon, has been widely practiced for many years as a method of oesophageal replacement. This involves placement of the right or left colon substernally or behind the hilum of the lung on the right or left side. To avoid stricture or ulceration at the cologastric anastomosis, vagotomy and a gastric drainage procedure are typically performed. Complications after colonic interposition include cervical anastomotic leak, stricture and intrathoracic redundant colon with stasis, gastric reflux, respiratory problems and diarrhoea.

Reversed gastric tube as a substitute is preferred by some surgeons. A tubularised portion of the greater curvature is brought up to the cervical oesophagus in the substernal or retrohilar position. This procedure has similar complications as described for colonic interposition. A portion of the greater curvature of the stomach can be fashioned into a "free" tube graft based on the right gastroepiploic artery; and this is used as a modification of the reversed gastric tube for oesophageal replacement.

**65**

provided the original work is properly cited.

Samuel Osei-Nketiah\* and William Appeadu-Mensah

\*Address all correspondence to: oseivatican@yahoo.com

*Oesophageal Atresia: Drowning a Child in His/Her Own Saliva*

Oesophageal replacement can also be achieved using the jejunum, both in a Rouxen-Y fashion and as a free graft with microvascular anastomosis. Recently, a wellestablished method for oesophageal replacement is the use of gastric transposition.

During the early years, the surgical management of OA was associated with lots of challenges and high mortality [1–4]. Respiratory failure, inadequate resuscitation, and complications of prematurity resulted in most deaths in the past. Complications of the surgical repair of the oesophageal atresia itself, particularly sepsis after dehiscence of the oesophageal anastomosis, and prolonged poor nutri-

Over the past two to three decades, however, the surgical outcome has improved

Gastro-oesophageal reflux and poor oesophageal clearance due to some degree

of ongoing oesophageal dysmotility may limit long-term survival. Dysplastic changes in the lower oesophageal mucosa may predispose to oesophageal carcinoma. Ongoing gastro-oesophageal reflux is a significant risk fact for oesophageal

significantly in most centres in the developed countries. This improvement is attributed to advances in neonatal anaesthesia, well-established neonatal intensive care units (NICU), availability of total parental nutrition (TPN) and refined surgical skills [1, 5–8]. The current major cause of mortality in most developed countries is from associated major congenital abnormalities. Death from prematurity or oesophageal complications is now rare. In view of this, the previously used Waterston classification has little relevance in developed countries. The prognosis however remains poor in developing countries where late presentation is the norm.

Waterston classification may remain relevant in these countries.

carcinoma. Hence, regular surveillance in these patients is important.

*DOI: http://dx.doi.org/10.5772/intechopen.84525*

tion are other major causes of mortality.

**2.14 Outcome and conclusion**

**Conflict of interest**

Nil.

**Author details**

Accra, Ghana

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Department of Surgery, University of Ghana School of Medicine and Dentistry,


**Table 10.** *Commonly used oesophageal replacement techniques.*

Oesophageal replacement can also be achieved using the jejunum, both in a Rouxen-Y fashion and as a free graft with microvascular anastomosis. Recently, a wellestablished method for oesophageal replacement is the use of gastric transposition.
