Colonic interposition, a contemporary experience: technical aspects and outcomes
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ORIGINAL ARTICLE
Colonic interposition, a contemporary experience: technical aspects and outcomes Naomi M. Fearon1 · Helen M. Mohan1 · Michelle Fanning1 · Narayanasamy Ravi1 · John V. Reynolds1 Received: 8 July 2020 / Accepted: 26 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract Colonic interposition is rarely used as an oesophageal replacement after resection, as the preferred use of stomach involves less anastomoses and lower risks of major complications. The functional outcome from the colonic conduit is also unpredictable. This report documents the spectrum of experience of a high-volume oesophageal centre, highlighting indications, techniques and functional outcomes. A retrospective review was undertaken of a prospective database from 2012 to 2016. Four of 252 (1.5%) cases in this time period utilised colon interposition. Two cases were for gastric conduit necrosis following oesophageal cancer resections, one for caustic ingestion with both an oesophago-bronchial fistula and gastric injury, and one for a primary oesophageal malignancy in a patient whom previously had a total gastrectomy. All patients had either a retrosternal or posterior mediastinal isoperistaltic right colon conduit placed. Two of three cancer patients are alive and disease free at 3 and 5 years, respectively. Surviving patients are weight stable and tolerating a normal diet. Both report excellent quality of life using validated assessment tools. Colonic interposition is rarely required in modern oesophageal practice, but with this technique good long-term nutritional and functional outcomes can be obtained. It is required in the armamentarium of a specialist centre, and training given its rarity may require novel approaches such as simulation and cadaveric-based training Keywords Colon interposition · Oesophageal cancer · Upper gastrointestinal surgery · Surgical techniques
Introduction In the modern era, the stomach is the standard conduit used for oesophageal reconstruction after resection. It usually provides ample length and vascularity to enable cervical or high thoracic anastomosis. Rarely, it may not be utilised as an upfront consideration, such as in patients who have had previous gastric surgery, or at the time of surgery where gastric blood supply and perfusion is deemed inadequate [1]. The most common indication, however, to consider an alternative conduit to stomach is probably from gastric tube necrosis post-oesophagectomy, a devastating problem with a high mortality rate, where reconstruction may be undertaken months after conduit removal and cervical oesophagostomy [1–3]. This is rare, a recent publication of over 2000 oesophagectomy cases from the Esophageal Complications * Naomi M. Fearon [email protected] 1
Consensus Group reported a 1.3% rate [4]. Another indication is where the oesophagus and stomach are irreversibly injured by caustic injury. Where an alternative is required, the colon is the usual substitute, preferable to small intestine in view of its length. Colonic interposition was fi
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