Revisional surgery after colon interposition for benign oesophageal disease *

Abstract

Although the short-term results of colon interposition for replacement of the oesophagus in part or as a whole are known to be satisfactory, there have been several reports of functional problems associated with total replacement in the long-term follow-up of patients. We have retrospectively studied patients who have required revisional surgery for anatomical and functional sequelae over a 7- to 38-year period. Although the short-segment colon interpositions have been relatively trouble free, several mechanical and functional problems requiring revisional surgery have been encountered in the long-term follow-up of patients who underwent long-segment colon interposition.

Surgical management of failed colon interposition☆

“…Curret-Scott and colleagues reported an incidence of seven intractable strictures in a series of 53 patients with colon bypass for benign disease. Jeyasingham and colleagues reported eight revisions for stenosis in 365 patients [6]. Demeester reported four anastomotic revisions in 92 patients [2].…”

“…Belsey's group reported on the need for revision surgery after colon interposition for benign disease in 29 out of 365 patients [6]. Most complications occurred in patients with long-segment colon bypass (27 out of 29).…”

“…Although it is often the last option available to reconstruct the gastrointestinal tract, colon interposition provides satisfactory swallowing in most patients. Nevertheless, long-term function may be impaired by redundancy, intrinsic disease, stricture, fistula, or ischemic complications [5][6][7].…”

Colon interposition for esophageal replacement: a single-center experience

“…Interponat redundancy causes obstruction symptoms (dysphagia, regurgitation) and may necessitate re-operation [8,16,17,18,20,36]. The rate of graft redundancy after colon interposition varies between 3.4% and 25% [16,17,18,20,36].…”

The Kagoshima consensus on esophageal achalasia

“…Sixty‐nine of these reconstructions were long, while 296 were short interpositions between the subaortic esophagus and the posterior stomach 52 . For the long ones, ischemia at the distal extremity of the transplant is perceived as a risk for fistula and stricture formation at the cervical anastomosis while redundancy at the supraaortic, supradiaphragmatic, and subdiaphragmatic levels become responsible for functional and mechanical dysfunction that may require reintervention 53 . The short segment colonic transplant is an iso‐peristaltic colon replacement based on either the middle colic or the left colic arterial supply and is generally perceived as an excellent operation, with minimal and mostly preventable morbidity.…”