Salvage of colon interposition by antethoracic free jejunal transfer

Isoperistaltic left colic graft interposition via a retrosternal approach for esophageal reconstruction in patients with a caustic stricture: mortality, morbidity, and functional results

PURPOSE

To report our results of treating esophageal caustic stricture with an isoperistaltic left colic graft interposed via a retrosternal route.

METHODS

We reviewed 70 patients who underwent substernal left colon interposition, performed retrosternally, for an esophageal caustic stricture, between January, 1999 and December, 2011.

RESULTS

The median operative time in this series was 3 h. A pharyngoplasty was performed in 10 patients (14.28 %), the thoracic inlet was found to be enlarged in 33 patients (47.1 %), and posterior cologastric anastomosis was performed in 58 patients (82.8 %). Two patients (2.8 %) died. Minor and major postoperative complications developed in 28 patients (40 %), including graft ischemia in 2 (2.8 %) and cervical anastomotic leakage in 14 (20 %). Five patients (7.14 %) developed a cervical anastomotic stricture. The functional results were satisfactory.

CONCLUSION

Retrosternal isoperistaltic left colic transplant interposition is an excellent long-term replacement for an esophageal caustic stricture. If performed by experienced surgeons, this procedure is effective for esophageal reconstruction.

Left colonic graft in esophageal reconstruction for caustic stricture: mortality and morbidity

The adequacy of the blood supply to the left colon graft and its ability to transport food effectively from pharynx to stomach made it an esophageal substitute of choice, particularly in esophageal caustic stricture. From 1999 to 2009, 60 patients underwent colon interposition for esophageal caustic stricture (n= 57) and cancer (n= 3). An isoperistaltic colonic graft based on the left colonic artery could be used in all of these patients. The substernal route was used exclusively, and upper thoracic inlet was opened when necessary. The isoperistaltic left colonic graft interposed by substernal route represents the surgical procedure of choice in all operations performed for esophageal substitution during the study period. The operative mortality rate was 3.3%. A cervical fistula occurred in 10 patients (16.6%) and cervical anastomotic stricture in five patients (8.3%). Dilation was required in all the stricture of the esophageal colonic anastomosis with good response. The isoperistaltic left colic transplant supplied by the left colic pedicle is an excellent long-term replacement organ for the esophageal caustic stenosis. When performed by experienced surgeons, the left isoperistaltic esophagocoloplasty is a satisfactory surgical method for esophageal reconstruction with acceptable early morbidity and good long-term functional results.

Colon interposition for esophageal replacement: current indications and long-term function

BACKGROUND

In contrast to the use of the stomach as an esophageal substitute, the use of the colon is becoming uncommon.

METHODS

From 1985 to 1995, 60 patients underwent colon interposition for esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), achalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esophageal bed in 38 patients (63.3%), under the sternum in 21 patients, and under the skin in 1 patient.

RESULTS

Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seven patients (13.5%) required dilation of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as the sole independent predictor of a good functional result (p = 0.002).

CONCLUSIONS

Colon interposition for esophageal substitution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed.

Bowel interposition for esophageal replacement: twenty-five-year experience

BACKGROUND

From 1972 to 1996, bowel interposition reconstruction after esophagectomy for benign and malignant conditions was performed in 129 of 131 patients. The indication for operation was benign disease in 94 patients (72.9%) and malignant disease in 35 patients (27.1%). Benign stricture was the most common presentation in the benign group (41 patients), and adenocarcinoma was the most common indication in the malignant group (19 patients).

METHODS

One hundred thirty-three conduits were performed in the 129 patients. Four patients (3.1%) required reoperative reconstruction. Of the 97 conduits employed for reconstruction of benign disease, the right colon was used in 70 patients, the left colon in 9 patients, and the transverse colon in 4 patients. A jejunal interposition graft was employed in 11 patients and a free jejunal autograft in 3 patients. The right colon was used in 15 patients with malignant disease, the left colon in 9 patients, and the jejunum in 12 patients.

RESULTS

The mean age of the population was 54.5 years (range, 14 to 72 years) with a male-to-female ratio of 1.3:1. The average number of prior thoracic or abdominal procedures was 2.9 (range, 1 to 8) with 50.9% of patients undergoing reoperation. The mean length of stay was 21.7 days (range, 8 to 290 days). Complications occurred in 37.1% of patients with anastomotic leak occurring in 14.8% and ischemic colitis in 3.0% of conduits performed. The in-hospital mortality was 5.9%.

CONCLUSIONS

Bowel interposition reconstruction after esophagectomy for benign and malignant disease can be performed with an acceptable morbidity and mortality, despite prior operative procedures in the abdomen or chest. Colonic and jejunal conduits, employed alone or in combination, can effectively restore gastrointestinal continuity.