Antesternal Colonic Interposition for Corrosive Esophageal Stricture

Abstract

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature.

Colon interposition in the treatment of corrosive esophageal strictures: 100 patients in seven years

“…endoscopic dilatations), to maintain an adequate lumen of esophagus is possible. 12 Requiring frequent admissions and anaesthesia, endoscopic dilatations have been reported to have a high incidence (48%) of recurrent stricture formation by Ogunleye et al 2,13 Surgery offers a one-time solution to a chronic problem of stricturerelated symptoms. Historically the first coloplasty was realised by Kelling, and the first successful use of a colon after esophagectomy in by Hacker.…”

“…13 These have not been seen often in literature and support our data that leaving behind esophagus at the expense of reduced morbidity and mortality is justified. 2,13 The stomach is deliberately kept intact for functional outcomes. In this situation, a functional reservoir is created and the patient has less acid and bile reflux then when performing the gastric pull up procedure.…”

“…1 While endoscopic dilatation is indicated in patients with short-length strictures, long or multiple strictures require surgical intervention in some form or other in long run. 2 Colon interposition for corrosive esophageal strictures has good results with freedom from debilitating dysphagia. pathology and complications.…”

Minimally invasive oesophagectomy for corrosive stricture oesophagus

“…Also mediastinum is not entered and so perioperative morbidity is reduced. 7 On the contrary people who claim that oesophageal resection should be offered states that long term complications such as malignancy, mucocele are avoided especially in younger patients. 8 They also proposed that if orthotropic posterior mediastinal route is used which is considered to be the shortest possible route from abdomen to neck, anastomotic complications can be reduced.…”

Ileocolonic Transposition Esophagogastric Bypass as an Antireflux Treatment for Corrosive Esophageal Injury

“…We ligated with silk 1.0 at the distal esophagus. An ileoesophageal anastomosis without an esophagectomy is relatively easier and quicker to perform and does not require a thoracotomy [ 13 ] to prevent further blood loss. This also reduces surgery times.…”