Colonic interposition is a surgical procedure that replaces a section of your child’s damaged or otherwise underdeveloped esophagus with tissue from their colon (large intestine). The surgeon removes a section of the colon to reconnect the remaining esophagus to allow your child to swallow. Surgeons commonly use the colonic interposition procedure or a gastric pull-up procedure to repair the damaged esophagus.

What Is Colonic Interposition?

Colonic interposition is a technique that uses a section of your child’s colon to replace the damaged section of their esophagus. Your child’s colon and esophagus are studied closely to identify the best section of the colon to connect the remaining esophagus and stomach. At the end of the procedure, your child’s entire digestive system is reconnected to allow for proper digestion.

Conditions Requiring Colonic Interposition

A variety of conditions may require a colonic interposition procedure, particularly in infants and children. Colonic interposition is most often used following the surgical removal of a section of the esophagus (esophagectomy).

Your child may require colonic interposition due to:

• Ingestion of a toxic or corrosive substance, called caustic ingestion
• Improper formation of the esophagus at birth, as in Tracheoesophageal Fistula (TEF) and/or Esophageal Atresia (EA)

How Does the Procedure Work?

During the operation, a section of your child’s colon is removed. This living tissue is called the colon graft. The graft is used to reconnect the remaining esophagus and stomach. The length of colon segment varies based upon your child’s specific situation.

The video below shows 3D animation of the colonic interposition procedure.

Preparing for Surgery

Your surgeon and nurses will provide specific instructions based upon details of your child’s operation. These instructions will include information about eating, drinking or g-tube feeds prior to surgery and when to arrive at the hospital if you are not already admitted. Your doctor or nurse will ask about your child’s medications and will let you know if you need to withhold these medications for a short time before surgery.

You, your child and other family members may be scared about the surgery. This is completely normal. Please share concerns with doctors and nurses. Also, Child Life representatives have assembled tips and resources to help you prepare for your visit so that you and your child are as comfortable as possible.

If you are traveling to Cincinnati for surgery, our Guest Services representatives are happy to assist in planning your stay. If you are traveling internationally, our International Patient Care team is ready to assist you.

Possible Risks and Complications of Surgery

As with any surgical procedure, there are possible complications. Potential risks include:

• Trouble swallowing
• Weight loss
• Gastrointestinal reflux
• Pneumonia
• Narrowing of the esophagus

Some complications may require additional treatment and/or surgery.

Recovery

Your surgeon will provide specific instructions during your child’s recovery period.

Initial recovery from colonic interposition lasts about two months, including a hospital stay of 10 to 21 days.

Typically, your child will receive intravenous (IV) nutrition for the first five to seven days after the operation. Your child may then be allowed to have liquids by mouth or tube feedings may be started. Your child should also use a pillow to raise the head while sleeping. This will prevent stomach acid from moving upward into the esophagus.

Within the first weeks after surgery, your child may have some trouble swallowing, feel full more quickly, and may have episodes of diarrhea and fatigue. These side effects lessen over time as your child’s body adapts.

The doctor will continue to monitor your child’s condition in the following weeks and months. This monitoring will include office visits and endoscopies in the operating room. Depending on your child’s progress, you may need to see your doctor for follow-up visits in coming years.