Between 1970 and 1988, 12 restrosternal esophageal substitutions using an ileocolic interposition were performed. The ages of the 12 children ranged from 2 to 6 years. In 11 children the esophageal strictures were secondary to ingestion of caustic liquid. All patients had failed esophageal dilation therapy. One death occurred on the 7th postoperative day following an episode of cardiac arrest at surgery. Early postoperative complications included three cervical ileoesophageal anastomotic leaks, which healed spontaneously. One patient had gastrointestinal bleeding 10 years postoperatively. This was controlled by antacid therapy without recurrence. Redundancy of the interpositioned ileocolic segment was observed in three children. All 11 surviving patients can eat a normal diet and have normal growth and development.