Replacements of the esophagus can be used in case of malformations, injuries or acquired conditions. The new esophagus should allow normal oral feeding, with little or no gastro-oesophageal reflux, and be able to work well for the life-time of the patient. Many substitutes have been used since a century, such as segments of colon, entire stomachs, gastric tubes or parts of the small bowel. But no one is perfect and operates as a normal esophagus.
Esophageal replacements are demanding challenges for the surgeons. We shall review the different techniques and the pitfalls related to these procedures based on our personal experience of more than 280 esophageal replacements in children performed since 1989.