The colon as oesophageal substitute in non-malignant disease *1Long-term clinical results and functional studies

Abstract

Between 1974 and 1987, we performed 18 left colonic interpositions for benign oesophageal disease: caustic lesions in 6 patients, undilatable reflux stenosis in 5, reoperative peptic strictures in 5, penetrating wound in 1 and iatrogenic stricture following oesophagogastric transection for bleeding in 1. Four patients were women. The mean age was 40 +/- 19 years. In 10 patients a left thoracotomy was used; in the other 8 a cervico-abdominal approach was employed. One patient died postoperatively from liver failure. The mean follow-up was 11 +/- 4 years. Clinical results were excellent or good in 12 of the remaining 17 patients (71%). These results varied according to the length of colon interposition; in patients with long colonic interposition, poorer results were achieved. The motor activity of the colonic transplant was evaluated by manometric studies. After intraluminal injection of 30 ml of liquid, the colon responded uniformly with sequential peristaltic waves. Transmission of the oesophageal waves through the oesophagocolic anastomosis was studied in 2 patients. After wet swallows, the oesophageal contractile waves were followed by colonic waves. Solid radionuclide colonic transit studies were carried out in 18 control subjects and in 18 patients with colon interposition. In subjects with a normal oesophagus, the general pattern was rapid emptying of the bolus through the oesophagus. Findings in patients with a short transplant were similar to those observed in normal oesophagi. In most patients with long transplants the transit was abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic Interposition After Esophagectomy for Cancer

“…14,19 Colonic conduits are reported to have active peristalsis, and this is presented as an explanation for their superior function as an esoph-ageal substitute compared with a passive gastric conduit. 30,31 Although peristalsis can be demonstrated immediately after surgery, 32 long-term emptying likely relies on gravity. 33 When the distal stomach is retained in the abdomen after a colon interposition with a cologastric anastomosis, the latter provides additional reservoir function.…”

Left Colon Substitution with His’ Angle following Total Gastrectomy

“…Isolauri et al [20]showed that radionuclide transit of the colon graft for the esophagus was markedly slower than that of the normal esophagus and suggested that reconstruction with proximal cologastric anastomosis and a short intra-abdominal colon graft segment would be preferable. Paris et al [21]reported that solid radionuclide colonic transit findings in patients with a short transplant were similar to those observed in the normal esophagus. We also documented the usefulness of a short segment of colon following proximal gastrectomy [14].…”

Interposición de colon transverso como alternativa de reconstrucción tras la esofagogastrectomía total

“…De las opciones antes mencionadas la que tiene más popularidad entre los cirujanos es la coloplastía derecha, ya que requiere una movilización del mismo menos agresiva, con la ventaja de ser isoperistáltica por necesidad manteniendo en forma teórica una mejor función de deglución [11][12][13][14][15] .…”

“…Debido a que se ha visto que el colon ascendido tiene actividad peristáltica, el realizar el injerto de forma isoperistáltico, lograría tener una mejor función de deglución, sin embargo, cuando la prueba del clampeo de los vasos cólicos izquierdos no es satisfactoria se opta por la coloplastía anisoperistáltica pediculada en los vasos cólicos medios [11][12][13][14] .…”