Minimally invasive substernal colonic transposition for corrosive strictures of the upper aerodigestive tract

Abstract

Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.

Treatment for postchemoradiotherapy hypopharyngeal stenosis: Pharyngoesophageal bypass using an anterolateral thigh flap—A case report

“…Finally, colon transposition (Banerjee & Saranga Bharathi, ; Tettey et al, ) is also a feasible reconstructive option. Possible disadvantages described include fistulas, proximal stenosis of the anastomosis, complications of the donor site, and transient paresis of the recurrent laryngeal nerve, among others.…”

“…When dilatation attempts fail, further surgical treatment may imply organ resection, complex reconstructive procedures, and functional disabilities. These complex procedures include the following options: sternocleidomastoid myocutaneous flap (Paknezhad, Borchard, & Lee, ), jejunal (Clark et al, ; Hsieh, Yang, Tsai, Kuo, & Lin, ; Tan et al, ; Welkoborsky, Deichmuller, Bauer, & Hinni, ; Yu, Lewin, Reece, & Robb, ); radial forearm (Clark et al, ; Tan et al, ); anterolateral thigh (ALT) flap (Clark et al, ; Piazza, Taglietti, & Nicolai, ; Tan et al, ; Yu et al, ); rectus abdominis (Clark et al, ); gastro‐omental flaps (Clark et al, ); and colon transpositions (Banerjee & Saranga Bharathi, ; Tettey et al, ).…”

Transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy for the management of esophageal caustic injury

“…Caustic ingestion as an attempted suicide has an unknown prevalence [1]. The profile of these patients is usually young adults [2,4] and morbidity and mortality are estimated at rates above 20% [1,2]. The presence of symptoms and their characteristics vary according to the severity of organ involvement, time of ingestion, type of substance and etiology of the lesions [1], ranging from oligosymptomatic cases to dramatic cases with perforation of organs and peritonitis [3].…”

“…Ingestion of caustic substances, besides being a medical emergency with high morbidity and mortality, is also an important cause of sequelae [1]. Its effects may range from necrosis [2] to perforation in the digestive tract, which may involve the mouth, pharynx, esophagus and stomach [1].…”

“…These lesions are found in children and adults, however, the etiology differs between accidental and intentional suicide attempts, respectively [[1], [2], [3], [4], [5], [6]]. Therefore, in children the lesions tend to be less severe, since the ingested volume is lower than the volume ingested by adults in an attempted suicide or homicide [1].…”