Minimally Invasive Retrosternal Esophageal Bypass Using a Mid‐Colon Esophagocoloplasty for Corrosive‐Induced Esophageal Stricture

Abstract

Introduction Colonic bypass for corrosive-induced esophageal stricture is traditionally performed using an open approach. The laparoscopic mid-colon retrosternal esophageal bypass has not been previously reported. The present study is aimed to report the feasibility of laparoscopic mid-colon esophagocoloplasty and to compare the short-and medium-term outcomes with the open approach. Materials and methods Patients who underwent surgery for corrosive esophageal stricture between August 2016 and August 2019 were retrospectively analyzed. Laparoscopic procedure was preferred in patients with stricture starting at or below the level of cricopharynx and without prior laparotomy. The perioperative and medium-term outcomes of patients who underwent open and laparoscopic mid-colon bypass were compared. Results Of the 15 patients, seven patients underwent laparoscopic mid-colon bypass, and eight patients underwent the open procedure. The duration of surgery was less in the laparoscopic group, but the difference was not significant (440 vs. 510 min, P = 0.93). Intraoperative blood loss (median) and postoperative analgesic requirement (median days) were significantly lower in laparoscopic group (200 mL vs. 350 mL, P = 0.03 & 3 vs. 5, P = 0.02). There was no significant difference in the postoperative complications, ICU and hospital stay between the two groups. At a median (range) follow-up of 14 (7-42) months, all patients in the minimally invasive colon bypass group were euphagic to regular Indian diet. Two patients in the open group developed anastomotic stricture requiring endoscopic dilatation. Conclusion Minimally invasive mid-colon esophageal bypass is a feasible procedure for selected patients with corrosive esophageal stricture with favorable short-term and comparable medium-term outcomes.

Minimal access surgery of corrosive and thermal strictures of the foregut

“…[ 12 , 19 , 23 , 24 , 26 , 34 , 36 , 41 ] Most are isoperistaltic, based on left colic vessels (especially its ascending branch), favored owing to its unvarying anatomy, optimal luminal diameter, presence of marginal arcade and robust blood supply. [ 12 , 19 , 23 , 32 , 35 , 36 , 41 , 55 , 56 ] Long conduits, including distal 15 cm of ileum, can be based on left colic vessels. [ 26 , 32 , 56 ] Ileo-colic valve prevents reflux proving advantageous.…”

“…Concentrated alkalies and acids used for household cleaning are the commonest causative agents for CS worldwide, with alkalies being more common in the West and acids in the East. [ 1 , 2 , 8 – 25 , 27 – 41 , 43 – 49 ] Uncommon, yet equally damaging, are zinc chloride and hot coffee. [ 26 , 42 ] Ingestion of caustics exhibits bimodal age distribution.…”

“…[ 54 ] Pre-operative radiologic assessment of colonic length and vasculature is recommended, but often omitted in the young as atherosclerotic obliteration of vessels is uncommon. [ 6 , 12 , 19 , 23 , 32 , 34 , 41 , 55 , 56 ] Most patients undergo repeated endoscopic dilatation/bouginage [ Table 1 ] to maintain adequate lumen (>14 mm for 4 weeks) for nutrition. [ 6 , 8 – 51 ] Unfortunately, repeated interventions create diverticulae and micro-ruptures which perpetuate inflammation and fibrosis.…”

“…[ 28 ] Though nasoenteral feeds suffice, most need surgical feeding access [ Table 1 ] for adequate nourishment (2500 Kcal, 1–2 g N/kg body weight) to attain >10 gm% hemoglobin and >3 gm% albumin, lest the anastomoses leak. [ 3 , 32 , 41 , 57 ] It may be augmented with parenteral nutrition prior to surgery. [ 43 ]…”

Acute Management in Corrosive Ingestion

“…These options might supplement dilation with better results. In cases of severe stricture, failure to dilate, or refractory strictures, surgery might be necessary (Figure 1) [4,18,19,[49][50][51][52][53][54].…”