Background
Our surgery department has long used Colon bypass for esophageal replacement. Two of our cases acquired esophageal perforation & required another graft using Gastric tube Esophagoplasty (GTE). In this work we shall highlight the outcome of reoperating on those cases.

Material and Methods
All cases have been operated upon previously by colon bypass procedure and were discharged after healing of the wound. Cases were prepared for reoperation after resuscitation & confirmation of esophageal perforation by contrast swallow. All cases used a Left Gastroepiploic vessel pedicled Gastric Tube Esophagoplasty using a gastrointestinal anastomosis stapler. Complications (postoperatively or during followup) as stricture or dysphagia were assessed and managed accordingly.

Result
Two male patients (with previous esophageal atresia & colon bypass esophageal replacement) acquired iatrogenic perforation. Interval between replacement procedures averaged 12 months. There were no recorded intraoperative complications in first or second procedures. One case acquired moderate dysphagia after 6 months and cervical stricture which were managed by multiple trials of dilatations by Savary-Gilliard dilators and stricturoplasty. The other patient had a cervical fistula that healed spontaneously. On follow up, both patients had normal weight for age, achieved normal swallowing & parents were satisfied with results.

Conclusion
Gastric Tube Esophagoplasty is a novel procedure that requires an adamant amount of skill and needs good general condition of the patient especially as reoperation procedures. The lack of preoperative GIT preparation & short operative time give GTE an edge to cure these patients. In cases operated upon before by colon by pass, the procedure is an ideal solution as a second conduit.