Unusual Sequelae of Colon Interposition for Esophageal Reconstruction: Late Obstruction Requiring Reoperation

Abstract

Colon interposition has become a favored technique for esophageal reconstruction. Late morbidity is generally related either to technical problems associated with the procedure or to the development of new disorders in the transposed segment. Two patients are discussed who were seen with obstruction of colon interposition grafts ten and five years after esophageal reconstruction. In the first patient, a volvulus of the interposed colon associated with a chronically narrowed area distal to the looped segment resulted in obstruction. In the second patient, the redundant intrathoracic segment of the colon interposition became kinked at the diaphragmatic hiatus leading to dilatation and incomplete emptying. Both patients underwent successful reoperations and are doing well 10 and 12 months later. The causes and possible prevention of these and other late complications of colon interposition are discussed.

Two-Point Fixation Technique in Retrosternal Midcolon Interposition for Corrosive Stricture of Esophagus-Our Experience With 25 Patients

“…Any redundancy in the colon can lead to the inability of the interposed segment to empty so that stasis, dilatation, and kinking can result. 4 When symptoms occur due to food retention in the colonic loop, surgical correction may be necessary to improve quality of life and to prevent complications such as aspiration if lifestyle modifications fail. 15 Diagnosis of colonic redundancy is established by barium swallow study findings showing abnormal dilation and/or elongation of the colon graft with a siphon like appearance of the distal segment of the transposed colon (Figure 6).…”

“…Careful suturing of only the seromuscular layer of the colon to the hiatus is critical. 4 DeMeester et al used a technique to secure the colon to the left crus with several 2-0 silk sutures after it is pulled straight to prevent late redundancy and to avoid herniation of abdominal viscera into the posterior mediastinum through the hiatus. 7 DeMeester et al mentioned fixation of the colon to the left margin of the opening in the diaphragm in the subxiphoid area in case of the substernal route and to the left crus of the diaphragm in case of posterior mediastinum route.…”

“…3 Late morbidity is generally related either to technical problems associated with the procedure or to the development of new disorders in the transposed segment. 4 The prevention and management of late postoperative complications is critical to the success of this operation and requires attention. 3 An important complication, in particular in later follow-up, is redundancy of the interposed colon, seen more after retrosternal interposition.…”

Dysphagia after Colon Interposition Graft for Esophageal Carcinoma

“…Other unusual sequelae, including paracolic hiatal herniation and herniation of small intestine through the mesocolon have been reported [6]. …”

Ösophagusresektion zur Behandlung der Achalasie Vier Fallberichte und Übersicht über die Literatur

“…Kontrovers wird die Wahl des Ösophagusersatzes diskutiert. Als Vorteil des Koloninterponates wird die geringere Gefahr eines gastralen Refluxes mit narbiger Anastomosenstenose gesehen [4,24,26], als Nachteil die mögliche Erweiterung des Koloninterponates mit der Notwendigkeit von Revisionen in bis zu 7% der Fälle [29,30], wie wir es auch bei einer unserer Patientinnen beobachteten. Nachdem der Magen als Ersatzorgan für die Speiseröhre nach Resektion wegen Karzinom bevorzugt zur Anwendung kommt [16,20], wurde -wie auch von der Mehrzahl der Chirurgen (Tabelle 4) -bei den übrigen Patienten dieses Verfahren gewählt.…”