A total of 28 colon esophageal replacements performed in children for long gap esophageal atresia (22 patients), and intractable caustic stricture (6 patients) were reviewed. Emphasis was placed on identifying the pros and cons of the different reconstruction techniques: intrathoracic route (ITR) (19 patients) and retrosternal route (RSR) (9 patients). No hospital mortality occurred, whereas a higher morbidity rate occurred among patients operated on using the ITR as opposed to the RSR (68% vs 55%; P not significant). Six patients developed an anastomotic fistula (21% with the ITR vs 22% with the RSR; P not significant), whereas an anastomotic stenosis occurred in 13 patients (67% with the RSR, and 37% with the ITR; P < 0.07). Overall, dysphagia was the most prevalent symptom at 3 months follow-up, but had significantly decreased at the final follow-up (54% vs 16%; P < 0.0027). Functional results improved significantly during the follow-up (score 1-2 vs score 3-4; Fisher test: P = 0.001). However, despite the higher morbidity rate, better functional results were achieved using the ITR as opposed to the RSR.