Colonic Interposition for Esophageal Atresia

1. Introduction

2. Abdominal Incision and Access to the Abdominal Cavity

1. Lysis of Adhesions

3. Kocherization of the Duodenum

4. Colon Mobilization Including the Splenic Flexure

5. Release of Attachments Around the Ligament of Treitz

6. Determination of Blood Supply and Length of Colon

1. Compare the Middle Colic and Left Colic Vascular Supply
2. Marginal Artery is Preserved

7. Construction of Colonic Interposition Graft

8. Stomach Mobilization

9. Excision and Repair of Gastrostomy Site

10. Transposition of Colon Posterior to Stomach

11. Cervical Incision and Mobilization of Esophagostomy

12. Formation of Tunnel

13. Passing of Colon Through Tunnel

14. Cervical Esophagocolonic Anastomosis

15. Distal Cologastric Anastomosis

16. Gastrostomy Creation

17. Reconstruction of Colonic Continuity via a Right to Distal Left Colocolonic Anastomosis

18. Closure of Mesentery

19. Gastrostomy Tube Placement

20. Abdominal Closure

1. Peritoneum
2. Anterior Fascia

21. Cervical Incision Closure

1. Place Cervical Drain and Reapproximate Muscles
2. Skin Excision
3. Reapproximate Platysma
4. Secure Penrose Drain to Skin

22. Skin Closure

1. Secure G Tube to Skin

23. Post-op Remarks