Esophageal reconstruction after caustic injury: is there still a place for right coloplasty?

Am J Surg. 2007 Jun;193(6):660-4. doi: 10.1016/j.amjsurg.2006.08.074.

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Burns, Chemical / complications*
  • Burns, Chemical / surgery
  • Caustics / adverse effects*
  • Colon / transplantation*
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / surgery*
  • Esophagectomy
  • Esophagoplasty / methods*
  • Female
  • Follow-Up Studies
  • Gastrectomy
  • Humans
  • Laparotomy
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Plastic Surgery Procedures / methods*
  • Retrospective Studies
  • Surgical Flaps
  • Treatment Outcome

Substances

  • Caustics