Clinical surgery–international
Esophageal reconstruction after caustic injury: is there still a place for right coloplasty?

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Abstract

Background

Through a systematic policy of using the right colon as an esophageal substitute, the authors analyze the reliability of this transplant for reconstruction after digestive caustic injury.

Methods

From 1995 to 2005, a right coloplasty was attempted in 81 patients after total esophagogastrectomy (n = 57) or for esophageal stricture (n = 24).

Results

The use of the right colon was not possible in 10 patients (12%) because of insufficient blood supply. In addition, postoperative right colic graft necrosis occurred in 5 patients. Cervical fistula occurred in 25 patients (31%). Opening of the thoracic inlet was associated with a lower rate of this complication (P = .04). At the end of the follow-up, 71 patients (88%) recovered oral feeding.

Conclusion

Attempt to use the right colon as an esophageal substitute failed in 18% of the patients. Despite high rates of cervical complications, in part linked to the peculiar setting of caustic injury, functional results remains satisfactory.

Section snippets

Patients

Eighty-one patients, who had an esophageal coloplasty for reconstruction after caustic injury between 1995 and 2005, were reviewed retrospectively. There were 32 women and 49 men. Their median age was 38 years (range 17 to 77 years). Caustic ingestion was accidental in 10 patients and suicidal in 71 (88%). Fifty-seven patients (70%) had undergone an emergency esophagogastrectomy performed by a stripping procedure [5] and 24 patients (30%) developed a secondary esophageal stricture unresponsive

Operative data

Median delay from caustic injury to esophagoplasty was 5 months (range 3 months to 50 years). Median preoperative ASA score was 1 (range 1 to 3). Median operative time was 5.5 hours (range 3 to 11 hours). In patients without pharyngeal stricture (n = 47; 58%), an esophagoileal anastomosis was performed in 40 patients (85%) and an esophagocolic anastomosis in 7 patients. A pharyngoplasty was associated to the esophagoplasty in 34 patients (42%) using the distal colon in 20 patients (60%), the

Comments

The colon has been widely used as an esophageal substitute following esophagectomy for carcinoma or for benign conditions such as congenital malformations, motility disorders, perforations, or caustic burns [13], [14], [15], [16], [17], [18]. To date, the choice between right and left colon for esophagoplasty is still debated, and results of both techniques are difficult to compare due to disparities in patients and surgical techniques in the reported series. In the present series, the choice

References (34)

  • M.M. Young et al.

    Esophageal reconstruction for benign disease: self-assessment of functional outcome and quality of life

    Ann Thorac Surg

    (2000)
  • E. Sarfati et al.

    Management of caustic ingestion in adults

    Br J Surg

    (1987)
  • N. Munoz-Bongrand et al.

    Diagnostic and management of digestive caustic burns

    J Chir

    (2002)
  • P. Cattan et al.

    Extensive abdominal surgery after caustic ingestion

    Ann Surg

    (2000)
  • N. Munoz-Bongrand et al.

    Ileo-coloplasty following eso-gastrectomy for caustic burns

    J Chir

    (2001)
  • M.D. Brette et al.

    Pharyngo-esophagoplasty by right coloplasty for the treatment of post-caustic pharyngo-laryngeal-esophageal burns: a report of 13 cases

    Ann Otolaryngol Chir Cervicofac

    (2000)
  • M.I. Surkin et al.

    Analysis of the methods of pharyngoesophageal reconstruction

    Head Neck Surg

    (1984)
  • Cited by (0)

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