An analysis of 112 children undergoing colonic replacement of the esophagus over a 30-year period is presented. The indication for esophageal replacement was atresia in 92 children and intractable stricture (peptic, caustic, or congenital) in 20. The procedure consisted of a transthoracic replacement of the entire esophagus in 82 cases and a partial replacement in 18, while a retrosternal replacement was used in ten cases. Two colon loops had to be abandoned prior to reconstruction due to irreversible ischemic damage. There were 15 deaths (13.4%)--all in the atresia group. Failure of the colonic graft was encountered in 16 patients (14.3%) and accounted for six of the deaths. Leakage of the proximal esophago-colonic anastomosis occurred in 54 cases (48.2%). Strictures of this anastomosis developed in 34 cases (30.3%). A total of 20 patients required operative revision of the anastomosis. The final outcome was excellent in 43 of 77 cases followed up for up to 24 years postoperatively (55.9%), good in 27 cases (35%), and only fair in seven cases (9.1%).