Alternative conduits for esophageal replacement

Abstract

Replacement of the native esophagus after esophagectomy is a problem that has challenged surgeons for over a century. Not only must the conduit be long enough to bridge the distance between the cervical esophagus and the abdomen, it must also have a reliable vascular supply and be sufficiently functional to allow for deglutition.The stomach, jejunum, and colon (right, left or transverse) have all been proposed as potential solutions.The stomach has gained favor for its length, reliable vascular supply and need for only a single anastomosis.However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. In this paper, we will briefly discuss the technical aspects of jejunal and colonic interposition. We will review the recent literature with a focus on early and late outcomes. The advantages and disadvantages of both options will be reviewed.

Laparoscopic-assisted Esophageal Bypass for T4b Esophageal Tumor as a Bridge to Definitive Therapy

“…The authors reported on safety, feasibility, and effectiveness of this technique, alongside the established advantages of minimally-invasive techniques, such as faster recovery, fewer respiratory complications, and minimal postoperative pain. In addition, laparoscopy can provide direct visualization of the substernal dissection (23). However, despite all the advantages of minimally-invasive laparoscopic approach, advanced tumor stage and compromised performance status are associated with higher rates of conversion to open procedure (laparotomy), as in our case (24).…”

Preoperative CT Colonoscopy for Esophageal Reconstruction with Colonic Interposition.

“…The Table 2. The colonic interposition could be performed by the left side, right side, and ileocolonic graft as the options for esophagectomy patients (3,(19)(20)(21)(22). Whatever the reconstruction, the quality of the colon should not be disregarded.…”

“…Preoperative colonic evaluation is the crucial step in providing intraluminal mucosal information for the surgeon who is responsible for performing reconstruction operations upon this group of patients. The literature reports preoperative investigation for colonic interposition being done by colonoscopy and barium enema (20)(21)(22). CT colonoscopy is a minimally invasive technique for colonic screening while avoiding the perforation risk from the colonoscopy procedure and unsuccessful cecal intubation.…”

Pharyngo-Ileo-Colo-Anastomosis With Micro-Vascular Blood Supply Augmentation for Esophago-Gastric Replacement Due to Esophago-Gastric Necrosis After Caustic Ingestion

“…In order to evaluate the type of colic graft to perform, a preoperative study with AngioTC 3-D of the abdomen and pelvis is very useful, which has 97.1% anatomical diagnostic accuracy of the mesenteric and colic vascular blood supply 8 . The rate of complications reported include necrosis of the flap (0-14%), anastomotic leaks (0-50%), anastomotic stenosis (0-32%), respiratory complications (10-42%), postoperative mortality (0-16.7%) 1 , 2 , 4 , 5 .…”