Repair of the marginal artery with an interpositional vein graft during colon interposition for esophageal reconstruction

Microsurgery ◽  
2020 ◽  
Vol 40 (7) ◽  
pp. 823-824
Author(s):  
Gokhan Sert ◽  
Shih‐Heng Chen ◽  
Hung‐Chi Chen
Keyword(s):  
Vein Graft ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Marginal Artery

scholarly journals COLON INTERPOSITION FOR ESOPHAGEAL RECONSTRUCTION (ESOPHAGOCOLOPLASTY)

2013 ◽  
Vol 9 (3) ◽  
pp. 225-233
Author(s):  
R.M. Neagoe R.M. Neagoe ◽  
Daniela Sala ◽  
D. Zamfir ◽  
S. Bancu ◽  
L. Kiss
Keyword(s):  
Colon Interposition ◽  
Esophageal Reconstruction

scholarly journals Colon Interposition for Esophageal Reconstruction in Cancer Patients

2018 ◽  
Vol 103 (5-6) ◽  
pp. 238-247
Author(s):  
Martin H. Hangaard ◽  
Michael B. Mortensen
Keyword(s):  
Cancer Patients ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Low Grade ◽  
Extensive Review ◽  
First Choice ◽  
Patient Reported ◽  
Esophagectomy For Cancer

Objective: The aim of this study was to report our experience with colon interposition (COI) and to compare the results with an extensive review of the COI literature. Summary of Background Data: The stomach is the first choice as an esophageal substitute following esophagectomy in cancer patients, while COI is reserved for patients where the stomach is not available or must be included in the resection due to cancer. Methods: We retrospectively reviewed the records of cancer patients undergoing colon interposition from 2006 to 2017. Outcomes were compared with an extensive review of the literature published between 2000 and 2017. Results: A total of 13 patients underwent planned COI. Mortality was zero and overall morbidity was 53%; 4 patients suffered from leakage and 2 patients from strictures. None of the patients suffered from necrosis of the interponat and there was no need for subsequent redundancy operations. The extensive review identified 23 publications. Overall study grading was low (grade C). Only 3 studies were prospective, no randomized studies were found, and many outcomes were poorly defined. The rates for 30-day and in-hospital mortality were 1% and 2%, respectively. Overall morbidity was 43%. The reported number of leakages, strictures, necrosis of the interponat, and redundancy operations varied between 0% and 50%, 0% and 21%, 0% and 9%, and 0% and 2%, respectively. Conclusions: COI is a complex technique that is necessary in a relatively small group of selected patients after esophagectomy for cancer. Prospective and comparative studies with strict outcome definitions, long-term follow up, and patient reported outcome measures are lacking.

scholarly journals Dysphagia after Colon Interposition Graft for Esophageal Carcinoma

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
C. Spitali ◽  
K. De Vogelaere ◽  
G. Delvaux
Keyword(s):  
Esophageal Carcinoma ◽  
Colon Interposition ◽  
Barrett Esophagus ◽  
Primary Adenocarcinoma ◽  
Esophageal Reconstruction ◽  
Colonic Interposition ◽  
Interposition Graft ◽  
Total Esophagectomy ◽  
Established Technique

Colon interposition is an established technique for esophageal reconstruction. We describe the case of primary adenocarcinoma arising in a colonic interposition graft that was performed after total esophagectomy for recurrence adenocarcinoma derived from the Barrett esophagus.

scholarly journals Clinical Utility of Three-dimensional Computed Tomography for Esophageal Reconstruction using Colon Interposition after Gastrectomy

2012 ◽  
Vol 62 (2) ◽  
pp. 143-146
Author(s):  
Izumi Takeyoshi ◽  
Hiroyuki Toya ◽  
Daisuke Yoshinari ◽  
Yutaka Sunose ◽  
Osamu Totsuka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Utility ◽  
Three Dimensional ◽  
Colon Interposition ◽  
Esophageal Reconstruction

Treatment protocol for secondary esophageal reconstruction using ‘supercharged’ colon interposition flaps

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
N Esmonde ◽  
W Rodan ◽  
K R Haisley ◽  
N Joslyn ◽  
J Carboy ◽  
...  
Keyword(s):  
Care Pathway ◽  
Clinical Care ◽  
Treatment Protocol ◽  
Oral Intake ◽  
Gastric Conduit ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Vascular Pedicle ◽  
Secondary Reconstruction ◽  
Clinical Care Pathway

Abstract Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a ‘supercharged’ accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a ‘supercharged’ vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30 days. Utilizing a ‘supercharging’ technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient’s oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.

“Supercharged” Isoperistaltic Colon Interposition for Long-Segment Esophageal Reconstruction

2013 ◽  
Vol 95 (4) ◽  
pp. 1162-1169 ◽  
Author(s):  
Kenneth A. Kesler ◽  
Saila T. Pillai ◽  
Thomas J. Birdas ◽  
Karen M. Rieger ◽  
Ikenna C. Okereke ◽  
...  
Keyword(s):  
Colon Interposition ◽  
Esophageal Reconstruction

scholarly journals COLOPLASTY: AN ALTERNATIVE TO GASTRIC PULL-UP IN BENIGN DISEASES OF ESOPHAGUS

2020 ◽  
pp. 1-3
Author(s):  
Nitin R Nangare
Keyword(s):  
Posterior Part ◽  
Vascular Anatomy ◽  
Single Layer ◽  
Functional Results ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Jejunal Loop ◽  
Esophageal Disease ◽  
Vagus Nerves ◽  
The Right

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. The choice of the colon as an esophageal substitute results primarily from the unavailability of the stomach. However, given its durability and function, colon interposition keeps elective indications in patients with benign or malignant esophageal disease who are potential candidates for long survival. The choice of the colonic portion used for esophageal reconstruction depends on the required length of the graft, and the encountered colonic vascular anatomy, the last being characterized by the near-invariability of the left colonic vessels, in contrast to the vascular pattern of the right side of the colon. Accordingly, the transverse colon with all or part of the ascending colon is the substitute of choice, positioned in the isoperistaltic direction, and supplied either from the left colic vessels for long grafts or middle colic vessels for shorter grafts. Technical key points are: full mobilization of the entire colon, identication of the main colonic vessels and collaterals, and a prolonged clamping test to ensure the permeability of the chosen nourishing pedicle. Transposition through the posterior mediastinum in the esophageal bed is the shortest one and thereby offers the best functional results. When the esophageal bed is not available, the retrosternal route is the preferred alternative option. The food bolus traveling mainly by gravity makes straightness of the conduit of paramount importance. The proximal anastomosis is a single-layer hand-fashioned endto- end anastomosis to prevent narrowing. When the stomach is available, the distal anastomosis is best performed at the posterior part of the antrum for the reasons of pedicle positioning and reux prevention, and a gastric drainage procedure is added when the esophagus and vagus nerves have been removed. In the other cases, a Roux-en-Y jejunal loop is preferable to prevent bile reux into the colon.To construct a colon interposition graft that is long enough, we examined a procedure in which the colon is transected proximally at the site of the cecum and the right colic artery is transected, in addition to ligation of the middle artery. Here we examined the series of 20 procedures for post-corrosive esophageal strictures treated with retrosternal colonic interpositions.

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