Purpose <p>This study evaluates the outcomes of transhiatal colon bypass, with or without esophagectomy, as a surgical intervention for esophageal replacement in pediatric patients with severe corrosive esophageal strictures, focusing on safety, complications, and long-term functional outcomes.</p> Materials and Methods <p>A retrospective analysis was conducted on pediatric patients who underwent transhiatal colon bypass between 2016 and 2019. The study included cases both with and without simultaneous esophagectomy. Standardized follow-up protocols were used to monitor complications, mortality, and long-term outcomes.</p> Results <p>Ten pediatric patients were included, with seven undergoing esophagectomy as part of the transhiatal colon bypass. The esophagectomy group had a significantly longer operative time (6.0 ± 0.7 h vs. 5.0 ± 0.4 h, p = 0.02). Intraoperative complications included vagus nerve injury (2 cases) and one intraoperative death. Postoperative issues included pneumonia (2 cases) and anastomotic leaks (2 cases). Long-term complications included anastomotic strictures and one case of intestinal obstruction. Despite these complications, both groups showed normal growth and good functional outcomes, with no significant differences in manometric results (<i>p</i> = 1.00).</p> Conclusion <p>Transhiatal colon bypass is a safe and effective option for esophageal replacement in pediatric patients with corrosive esophageal strictures. While esophagectomy increases surgical complexity and risks, it may be necessary in cases where the native esophagus poses long-term risks. Intraoperative assessment is crucial in deciding whether to include esophagectomy.</p>